Psilocybin approved for end-of-life care as momentum builds for psychedelic therapy

Four Canadians will soon become the first in the country to legally consume psilocybin since it was made illegal in 1974

By Samuel Riches

In early June, Thomas Hartle, a 52-year-old father of four from Saskatoon, who has been living with terminal cancer since 2016, sent a private video message to Patty Hajdu, Canada’s Minister of Health.

“People like myself are facing very real, very concrete, mental health issues,” he says in the video, which he shared with the National Post. “These are mental health issues and anxieties and depression that we feel could be addressed as easily as the stroke of a pen for you.”

Hartle was referring to an application he had sent to the minister weeks earlier for a Section 56 exemption to the Canadian Drugs and Substances Act. The exemption would allow Hartle to pursue psilocybin therapy for end-of-life distress. Psilocybin is a psychedelic drug derived from magic mushrooms.

This year, Hartle and at least three other Canadians  applied for the exemption. Earlier this week, more than 100 days after the first application was sent, they received good news. The exemptions were granted, meaning the four Canadians will soon become the first in the country to legally consume psilocybin since it was made illegal in 1974.

“Today is a good day,” Hartle said earlier this week.

Hartle completed his application with the assistance of TheraPsil, a B.C.-based, non-profit coalition of doctors and health-care professionals, policymakers, lawyers, researchers and advocates. Spencer Hawkswell, executive director of TheraPsil, says the need for psychedelic therapy is growing.

More On This Topic

“More individuals reach out every week, and I think many more across Canada would want to explore this option if they were aware of it,” Hawkswell previously told the Post.

“With so many Canadians diagnosed with terminal illnesses each year, and many choosing MAiD (medical assistance in dying), we hope to be another option for the patients who are experiencing end-of-life distress and want to try something like psilocybin,” Hawkswell says.

Hartle says that traditional anti-anxiety medications come with a range of unpleasant side effects and do not address the existential anxiety that he is feeling as he wrestles with the reality that he will be leaving his family behind. He believes psilocybin could help ease that pain and there’s no shortage of research to support his position.

A 2016 study from John Hopkins University demonstrated that psilocybin therapy led to significant and sustained decreases in depression and anxiety in patients with life-threatening cancer, in addition to improved quality of life and a renewed sense of optimism. Six months later, those changes persisted. About 80 per cent of participants continued to show substantial decreases in depression and anxiety.

Psilocybin-assisted psychotherapy is more than “just a trip,” Hawkswell explains. It begins with multiple preparatory sessions between the patient and therapist before the mushroom is consumed. The potential for breakthroughs comes in the moments of extreme anxiety, he says, as patients confront their negative emotions.

If we can do this the right way, and go through official channels, it will pave the way so other people can follow

“This is often where some of the most important psychotherapeutic work happens as patients let go of long-held negative beliefs.” The therapy concludes with multiple post-integration sessions, where the patient and therapist work through the experience.

“If we can do this the right way, and go through official channels, it will pave the way so other people can follow in my footsteps,” Hartle says. “I am hoping that, eventually, people like the Minister and Canadians in general, will see that people are benefiting from this, and it is not the harmful, non-beneficial substance that it has been portrayed as.”

Hawkswell says they’ve had a difficult time engaging the government in this discussion. In 2017, the organization’s founder, Dr. Bruce Tobin, applied for an exemption to treat dying Canadians with medically-supervised, psilocybin-assisted psychotherapy. After three years of limited communication with Health Canada, the application was denied.

Hawkswell hypothesizes that the original application was rejected because it was for a class of dying patients, not an individual. Since that ruling, they pivoted their strategy to focus on individual exemptions and, this week, the work finally paid off.

“We would like to extend our incredible gratitude to the Honorable Minister of Health, Patty Hajdu, and to our government,” Tobin said earlier this week. “Although it has taken a long time we are impressed with their willingness to listen to patients who have not been heard and to shift focus and policy to accommodate their interests and protect their needs.”Momentum for psychedelic therapy has been building across North America for the last several years.

In 2017, the U.S. Federal Drug Administration gave MDMA a breakthrough therapy designation for post-traumatic stress disorder. In 2018, they gave the same designation to psilocybin for treatment-resistant depression. In March of last year, the FDA approved a new antidepressant for the first time in decades, a nasal spray that mimics the effects of ketamine.

In March, Mind Medicine Inc., which received financial backing from Kevin O’Leary and Bruce Linton, began trading on Toronto’s NEO Exchange. The company’s first drug, 18-MC, is a derivative of ibogaine, a naturally occurring psychedelic from the root and bark of Iboga, a rainforest shrub that grows across West Africa. Ibogaine has shown promise in treating some of the world’s most destructive and damaging addictions: heroin, alcohol, methamphetamine and opioids.

Later this month, Paul Manly, the Green Party’s MP for Nanaimo-Ladysmith, will present a petition, initiated by the Canadian Psychedelic Association, that calls for the decriminalization of psychedelic plants and fungi. The petition has been signed by nearly 11,000 Canadians.

“There is a rapidly growing body of evidence that medicinal plants containing psychoactive ingredients can provide therapeutic benefits,” Manly previously told the Post. “They have been safely used to treat people suffering from addictions, common mental health issues such as depression and anxiety, as well as for end-of-life care.”For Hartle, and other Canadians living with a terminal diagnosis, this week’s decision is a welcomed one, and potentially, the beginning of a much larger movement. The legalization of cannabis, after all, can be traced back to a Section 56 exemption.

“This is the positive result that is possible when good people show genuine compassion,” Hartle says. “I’m so grateful that I can move forward with the next step of healing.”

Complete Article HERE!

You Can’t Avoid Death, But You Can Make It Easier

By

LIFE EVENTS
By Karolina Waclawiak

Do you know how to euthanize a bird? If not, you will just a few pages into “Life Events,” Karolina Waclawiak’s astute and distressing new novel.

Technically, euthanizing a bird isn’t that hard. All you need to do is make a concoction of simple syrup, a crushed anti-inflammatory pill and a crushed anti-anxiety pill, and administer it via an eyedropper. But as the protagonist, Evelyn, discovers, “the agony was in the waiting.” She has to sit by him for hours, watching him die after “dropping the mixture onto his tongue, hoping he would take the sip that would finally dull his pain.”

We meet Evelyn at 37, aimless, jobless, in the last stages of her dying marriage and consumed with grief over her parents’ impending death. It’s in this state that she notices a “hummingbird in distress” on the patio of her Los Angeles apartment, and resolves to put it out of its misery.

A few weeks later, Evelyn enrolls in a program for so-called death doulas, or people who come to patients’ homes to prepare them for euthanasia and be with them until the end. The narrative follows her training and then her work with three very different patients. Evelyn approaches the job with true devotion, but she fails at detachment — a requirement in this position. Evelyn is too present, too involved, too reckless — to the point of having to seek a Plan B pill after an encounter with one of the patients.

The job would’ve been unbearable if not for the alcohol and anti-anxiety pills that Evelyn takes to dull her own pain. Waclawiak accomplishes a brilliant feat here, creating an atmosphere of almost palpable, effortful dullness that presides over the entire novel. With so much opportunity for raw emotion, the author seems to avoid it at all cost, going for exceptional clarity instead.

In the absence of any real emotional attachment to the characters, the reader is forced instead to engage intellectually, to actually face the tough questions about our own inevitable death.

In the novel, the death doulas have to make sure that their patients make an informed decision rather than an emotional one; so as part of their training, they have to fill out the same questionnaires they give to their patients. In these passages the reader can’t help pausing and applying the questions to herself. One of the toughest questions asks what degree of livelihood constitutes a life worth living, on a scale from 100 percent (full health) to 0 percent (death). “By 60 percent, mobility was reduced and disease was significant,” Evelyn explains with clinical matter-of-factness. “Consciousness could waver between full, drowsy and confused.”

Imagining yourself functioning at 60 percent is scary enough, but it’s fully terrifying to think what will happen to you at 30 percent or below. An easier option would be to just keep your head in the sand and not think about death at all. And this is exactly what a majority of Americans are doing.

The health crisis we are living through has exposed many uncomfortable truths about our collective state of denial. Most people have reacted to the threat of Covid-19 as if this were the only possible cause of death, as if they’d never before fully considered their mortality. Tallying the pandemic’s daily fatalities with fanatical persistence, these individuals and public health officials are ignoring all the other deaths, praying for a vaccine that will allow them to finally relax, as if the prevention of one specific disease could render one immortal.

And even before Covid-19, our medical and cultural institutions would put so much effort into “defeating” death, which actually means prolonging life by just weeks or days at the cost of horrible suffering. Meanwhile, so little effort is put into helping patients accept their eventual death, effectively encouraging them to ignore mortality.

Waclawiak’s “Life Events” provides a powerful argument against that attitude. The novel offers you a hand, gently helping you pull your head out of the sand to accept the inevitable.

Complete Article HERE!

I visited a ‘green cemetery’ in California,

and it made me question everything about American funerals

By

  • A small network of cemeteries across the country are looking to shake up American burial practices and make them eco-friendly by offering “green burials.”
  • Green burial rejects cremation, embalming, and concrete-lined graves to reduce the carbon footprint of death.
  • A national survey found that over half of respondents were interested in exploring green funeral options because of potential environmental and cost-saving benefits.

Cindy Barath is the steward of a 32-acre property in the hills of Mill Valley, California, and all the bodies that come with it.

She spends her days planning ceremonies, receiving the bereaved, and caring for the dead. She’s honest at dinner parties about her job, and when people are surprised to hear that she personally dresses the corpses, she tells them, “Well, they don’t dress themselves.”

I met Cindy Barath on a cool October morning. I was a graduate student hoping to write an article about rocketing property prices putting pressure on the cost of a grave. My tentative headline was: “The cost of living is rising. Is the cost of dying, too?”

I arrived at Fernwood Cemetery looking for a story about real estate. But I found something different, and in my opinion, more interesting: a small movement looking to shake up American burial practices and make them environmentally friendly.

In a traditional American burial, a body is embalmed, then placed in a coffin and laid to rest in a concrete-lined grave. The custom is resource intensive. Each year, it uses 4.3 million gallons of embalming fluid, 20 million board feet of hardwood, and 1.6 million tons of concrete, according to the Green Burial Council.

The “green burial” movement looks to change that.

Barath offered me a tour of the property via her shiny black golf cart. We hop in and she hits the gas. We whip by eucalyptus trees, wood-chip trails, and the mounds of fresh graves.

Barath is not the funeral director I imagined. She has a warm, folksy demeanor, and wears her auburn hair in short curls that are closely cropped to her head. Her wardrobe reminds me of my high school home economics teacher — long, warm sweaters and a chunky gemstone necklace.

We pull up to a spot overlooking the hills, which are patched with light and shadow by the misty clouds overhead. It’s quiet, but if you listen closely, you can hear the distant chatter of recess from an elementary school a few miles away. “Sure beats the office,” said Barath with a chuckle, dismounting from the driver’s seat.

Green burials are generally defined by what they don’t do. They don’t cremate, which burns through gallons of fuel to turn the body to ash. They don’t embalm, which pumps formaldehyde into the body to preserve it. And they don’t line a grave with concrete, which slows decomposition.

But from there, the details vary. Customers can choose biodegradable containers that range from a pine box to a hand-sewn silk shroud. Some cemeteries offer flat stone markers, others record grave locations with a GPS tracking system. Fernwood even offers a mushroom suit, a shroud of fungal spores that aid in decomposition and detoxification.

Beyond Fernwood Cemetery, options abound for the late nature-lover. A Canadian design firm created an urn called “ROOTS,” made from coffee grounds and lime that will germinate a tree. A company called Better Place Forests is conserving hundreds of acres of land in California and Arizona where families can reserve a memorial tree to spread ashes. And an organization called Eternal Reefs can inturn your cremated ash into a concrete “reef ball” that restores ocean habitats.

A new name for an old practice

Although green burial is marketed as an eco-friendly choice, its customs existed long before the environmental movement. A simple burial without the frills of chemicals and concrete is ancient. Green burial is, essentially, a new word for an old practice.

Take Jewish burial traditions, for example.

“Jewish burial traditions and customs have been green for the last 3,000 years,” said Glenn Easton, executive Funeral Director at The Garden of Remembrance Memorial Park in Maryland. “In Israel, they don’t use caskets. They don’t embalm. They don’t use concrete liners. They use a shroud and put people in the ground.”

Easton says his Orthodox Jewish customers are especially green, since they prioritize letting a body decompose quickly. They even have a workaround called “butterdishing” for cemeteries that require concrete liners: they line the sides and top of the grave, and leave the bottom open to the earth.

Green burial isn’t too different from the way we bury the indigent, either. At potter’s fields across the country, governments bury those who are too poor to afford funeral services, or bodies that are unclaimed, in simple graves without coffins, concrete, or chemicals. The only difference: rather than a shroud or pine box, they are often buried in plastic body bags.

Unlike coffee-ground urns and “reefballs,” green burial is old technology. But while it doesn’t contribute much in terms of innovation, it does spark an important conversation. Green burial prompts us to ask why our rituals of death default to using formaldehyde and concrete.

In America, embalming can be traced back to the Civil War. The soldiers who died fighting on the battlefields of North Carolina needed to have their bodies transported back north to be buried. Preservation became a necessity.

Meanwhile, concrete liners can be traced to America’s obsession with the perfect lawn. Funeral directors say that they are useful for landscaping: they prevent the ground above a grave from sinking or collapsing. Many cemeteries require the concrete. It keeps things smooth for their industrial mowers.

The difference is apparent at Fernwood’s Green Cemetery. Rather than neat rows of gravestones and uniformly-trimmed fescue, the cemetery’s green burial sections are dotted with native grasses and shrubs. In parts, the landscape is steeply sloped. A lawnmower would have a tough time.

Changing times

The movement is still in its early days. There are at least 287 cemeteries in the US and Canada that offer green burial services, according to New Hampshire Funeral Resources. And at some of those cemeteries, like Wooster Cemetery in Connecticut, traditional burials vastly outnumber their green counterparts.

The cadre is small, but Ed Bixby, president of the Green Burial Council, which certifies green cemeteries, is hopeful. A national survey found that over half of respondents were interested in exploring green funeral options because of potential environmental and cost-saving benefits.

And Bixby says that end-of-life customs are more changeable than they seem.

Take cremation, for example. In 1975, only 6% of Americans chose cremation, according to the Cremation Association of North America. Traditional burial with embalming was standard.

Funeral directors considered cremation to be no more than “a flash in the pan,” said Bixby.

But it wasn’t. Cremation was a fraction of the price of traditional burial, and it was adopted widely.

Today, cremation is king. More than half of all Americans choose cremation, according to the National Funeral Directors Association. It surpassed traditional burial as the most popular end-of-life solution back in 2015.

Direct cremation, which forgoes a viewing or other ceremony, can cost as little as $750. But since green burial is less expensive than traditional burial, Bixby believes it could gain traction as the “official third option.”

Traditional burials, with a vault, cost a median of $9,135 in 2019, according to the National Funeral Directors Association. By forgoing embalming ($750), a cement vault ($1495), and opting for a simple shroud or pine box over a wood casket ($3,000), or metal burial casket ($2,500), those choosing green burial can save thousands.

Still, Glenn Easton emphasizes that at his cemetery, “green burials are not influenced or determined by financial decisions.” Instead, “they’re a philosophical preference.”

And Cindy Barath says that the simplicity of a green burial service, and emphasis its emphasis on nature, helps the bereaved. “I try to cut through all the red tape and make it easy and simple. Just help them make this transition. I know if they come in crying and come out laughing, something has taken place.”

Complete Article HERE!

The Death-positive Movement & The Order of the Good Death

by Carl Gregg

As of last week, more than 150,000 people have died from the coronavirus in the U.S. alone. And we should be honest that that number is likely an undercount due to inconsistencies in how various localities attribute COVID-19 as a cause of death (The New York Times). Worldwide, more than 600,000 people have died of Coronavirus (NPR). The death toll will continue mounting in coming months. So in such a time as this, taking a step back to reflect on our own mortality seems in order.

Now, I will readily confess that confronting the subject of death can feel like a lot to take on: it can be a heavy, freighted topic, but it is also incredibly important. As the saying goes, “None of us are getting out of this alive!” One option, of course, is denial: trying to avoid the topic of death as much as possible until our time inevitably comes. But I invite you to consider that there is a better way. Keeping our mortality in mind and cultivating practices supportive of dying well (to the extent that is within our control) can be a key part—and sometimes a deeply moving, meaningful, and beautiful part—of living well.

Along these lines, reminders of mortality can be a central practice in the Buddhist tradition. Indeed, some Buddhist traditions specifically include “four reminders” which are sometimes linked to the origin story of the Buddha. After all, the rich and privileged Prince Siddhartha was launched onto the spiritual quest that would lead him to become the Buddha precisely when he wandered outside the protected gates of his palace and encountered three visceral, existential reminders about impermanence and change. He encountered, in turn:

  1. Old age (a person whose body had grown frail)
  2. Sickness (a person whose body had become ill), and
  3. Death (a body that had died)

In each of these cases, the young Siddhartha Gautama—the future Buddha—realized, “I am not exempt”: I too will grow older, get sick, and someday die.

My intent is not to be unduly morbid. Instead, it is to realize that reminders of our mortality—that none of us are promised even the next moment—can wake us up into more fully and freely experiencing life. We’re not going to be around forever, so stop sweating the small stuff; let that [BLEEP] go. We’re not promised even tomorrow, so let’s make the most of this time that we do have here and now. Can you feel that aliveness, that edge that remembering our mortality can bring?

The fourth reminder is that contemplative practices offer us a path of liberation—not an escape from those first three reminders (old age, sickness, and death), but a way of transforming our relationship to unsatisfactoriness. As the saying goes, “We can’t stop the waves of change from coming, but we can learn to surf.”

If you will indulge me in a related tangent, part of what comes to mind when I think about death is sex. Not in a weird way, but in a free association to another of those other big, freighted parts of the human condition. And it regularly makes me proud to be part of the Unitarian Universalist movement that is more than five decades into a commitment to comprehensive, lifespan sexuality education. Our Whole Lives (affectionally abbreviated as OWL) was launched fifty years ago in 1970. (This program was originally called AYS, About Your Sexuality.) For more than five decades Unitarian Universalism has been at the forefront of the sex-positive movement: affirming a wide range of sexuality as natural and healthy and emphasizing safer sex practices, consent, body-positivity, and reproductive justice.

I bring up that longterm commitment to the sex-positive movement because we quite progressive UUs have some work to do to be equally as committed to the death-positive movement. Death-positive, you might be asking yourself, “What is that?” For the uninitiated, allow me to introduce you to Caitlin Doughty, my favorite death-positive advocate. Doughty describes herself as a “mortician, activist, and funeral industry rabble-rouser.” I highly recommend all three of her books:

  • her memoir Smoke Gets in Your Eyes: And Other Lessons from the Crematory
  • her travelogue From Here to Eternity: Traveling the World to Find the Good Death
  • her most recent book Will My Cat Eat My Eyeballs? Big Questions from Tiny Mortals about Death.

All her writing is equal parts hilarious and profound. Some of you may recall that four years ago, I wrote a blog post on mortality inspired by Doughty’s memoir, as well as by the physician Atul Gwande’s book Being Mortal. I highly recommend that book as well, if you or someone you love is wrestling with end-of-life medical decisions.

For now, I would like to share with you the eight central values of the Death Positive Movement as articulated by a group Doughty helped found, called The Order of the Good Death:

  1. Hiding death and dying behind closed doors does more harm than good to our society.
  2. The culture of silence around death should be broken through discussion, gatherings, art, innovation, and scholarship.
  3. Talking about and engaging with my inevitable death is not morbid, but displays a natural curiosity about the human condition.
  4. The dead body is not dangerous, and everyone should be empowered (should they wish to be) to be involved in care for their own dead.
  5. The laws that govern death, dying and end-of-life care should ensure that a person’s wishes are honored, regardless of sexual, gender, racial or religious identity. [More information available at “Death with Dignity“]
  6. My death should be handled in a way that does not do great harm to the environment. [More information available at “Green Burial“]
  7. My family and friends should know my end-of-life wishes, and I should have the necessary paperwork to back-up those wishes. [More information available at “Conversation Project” and Five Wishes”]
  8. My open, honest advocacy around death can make a difference, and can change culture.

And our culture is changing even if we still have a long way to go. One of the most pervasive death positive shifts is the Hospice Movement (which started in the 1960s and entered the U.S. in the mid-1970s). Hospice has initiated a much-needed sea change in according death greater dignity.

Relatedly, many of you may be familiar with doulas in the context of accompanying, guiding, and empowering people giving birth. There are also a growing number of people being trained as death doulas to accompany, guide, and empower people at the end of life.

And some of you may have also heard of or even participated in the Death Cafe movement, which was founded in 2004 as a way to connect people who want to talk about death in an open, honest way. As one of their promotional slogans says, Death Cafes, “never involve agendas, advertising or set conclusions. Interesting conversations are guaranteed!”

If you google “Death Cafe” (or visit deathcafe.com) and your zip code into the “Find a Death Cafe” link, you’ll find that the closest Death Cafes. You may even find one has moved to Zoom during the pandemic, and is open to all.

Here one description:

Death Cafes are an opportunity to demystify the death experience. We offer an open, safe environment for discussing thoughts and feelings about all manner of death and dying.

At a Death Cafe people drink tea, eat cake and discuss death. [“Life’s short, eat dessert first,” right?!] Our aim is to increase awareness of death to help people make the most of their (finite) lives…. Please note: Death Cafes are not meant to act as support groups or grief counseling.

If this post leaves you a little “death curious,” perhaps joining an upcoming Death Cafe might be right for you.

Overall, the hope is that being more open, honest, and transparent about our inevitable death can empower us to make the most of the life that we have. One ancient Buddhist inquiry practice puts it this way: “Since death alone is certain, and the time of death uncertain, what should I do?” 

As we sit with that question, allowing it to sink in, I want to conclude with a story. A few years ago my colleague the Rev. Georgette Wonders preached a sermon on the subject of death and mortality to Bradford UU Community Church in Kenosha, Wisconsin, the congregation she served as minister. That sermon was titled “Facing Death: The UU Book of the Dead.” She preached it on Sunday, August 6, 2014 with no knowledge at the time that she would be killed two days later in a car accident.

I invite you to reflect on the final section of Rev. Wonders’ sermon on “Facing Death: The UU Book of the Dead.” She is speaking to us from beyond the grave: both her words and the example of how she lived her life are part of the legacy that she had left behind as a gift for those of us still living. As you listen, notice if any words or phrases particularly resonate with you in this season of your life. Whether we are saying goodbye to a loved one—or whether we are the one being said goodbye to—the way we prepare is to:

  • Live each day as if it were the only day.… Every time you part, from this day forward, tell them you love them, even if you are in and out all day long.

  • Appreciate the little things—the common, everyday things—because they will become almost unbearably precious when death comes knocking at the door.

  • Overcome your resentments and learn not to accumulate them.

  • Be useful and light upon the earth.

  • Live a grateful life.

7 Items Your Estate Plan May Have Left Out

If your goal is to look out for your loved ones, consider tackling these estate-planning additional jobs.

By

Estate planning is the easiest financial-planning to-do to put off. It’s certainly not fun to ponder your own mortality, and yet that’s the very nature of estate planning. Lawyers are often involved, so it can be hard to get it done on the cheap. And while most financial-planning jobs provide at least some payoff during your lifetime, estate planning isn’t as much for you as it is for your loved ones.

Given all of those reasons, it’s no wonder that so many individuals put off creating or updating on an estate plan. But anecdotally, at least, the pandemic seems to be lighting a fire under some people to get serious about creating or updating their estate plans once and for all. It could be that they’ve been spurred on by the health crisis, which has already claimed too many lives, or they may finally have a bit of free time. A single friend had been lobbing questions at me about executorships and charitable bequests for several years now, but she recently texted me that she’s finally doing an estate plan. Another friend and her husband are updating their documents to reflect what has changed in their lives since they last prepared them. Among other adjustments, they’ve granted powers of attorney and executorship to their now-adult children rather than their siblings, who are aging.

Making sure you have the key estate planning documents in place is important; that means a will, an advance directive (or living will), powers of attorney for healthcare and financial matters, and guardianships for minor children, first and foremost. Trusts may also make sense in certain situations. But there are other add-ons that you can think about in the context of your estate plan, especially if your goal is to make life as easy for your loved ones as possible and to ensure that your wishes are carried out after your death. In contrast with a traditional estate plan, you can craft at least some of these documents on your own, without the aid of an attorney.

In my parents’ later years, I was intimately involved and eventually in charge of their finances, managing their investments, paying their bills from their bank account, and so on. When they eventually passed away, I didn’t have to hunt around for key documents or climb a learning curve about their finances.

But many of us don’t have or want that kind of backup in place, which is why I think it can be helpful to create a financial overview and master directory for your loved ones. (These documents can also come in handy if you’re the main financial decision-maker in your household and your spouse doesn’t pay too much attention.) A financial overview and master directory (the latter of which I’ve detailed below) go hand in hand.

A financial overview lays out the basics of your finances in a straightforward narrative. I think it can be especially helpful if your loved ones aren’t especially conversant in financial matters, or if they’re “words” people rather than numbers-oriented. (One way to think of it is that the financial overview is a Word document, whereas the master directory is Excel.)

I recently created such a financial overview for our household and included the following headings:

  • Our estate plan (in very broad outlines: where to find the documents and who the key agents are–POAs and executors).
  • Our key financial assets (no dollar amounts or account numbers; just where we hold the accounts and who owns them).
  • Our insurance coverage (property/casualty, health, life).
  • Our house (property ID number, whether there’s a mortgage).
  • Cars (VIN numbers, whether there are car payments).
  • Regular household bills that we pay.

2. A Master Directory
Think of a master directory as a detailed version of your financial overview. Whereas the financial overview is a Microsoft Word document, this is the Excel version. For example, your financial overview might say, “We each have 401(k)s through our employers: Emily’s is with Charles Schwab and Jake’s is with Fidelity.” But the master directory would include the actual account numbers for those accounts, the URLs, and the names of any individuals you deal with at those institutions. Because the master directory includes sensitive information, it’s crucial to encrypt it or, if it’s a physical document, to keep it under lock and key.

3. A Plan for Your Personal Property
Most wills will state that any tangible personal property, like furniture, should be sold and the proceeds added to your estate. But if you have sentimental or valuable items that you’d like to earmark for specific individuals, such as jewelry, artwork, or special home items, you can also create a memorandum of tangible personal property that specifies who you would like to inherit those items. For your own sanity, don’t go overboard in earmarking every little thing for specific individuals; focus on those items you treasure that will also have meaning for the recipients. I found that creating such a memorandum–and matching my favorite possessions to the loved ones in my life who I thought would appreciate them the most–to be one of the most enjoyable and cathartic aspects of the whole planning process. In addition, because the memorandum isn’t technically part of your will, you can update it as you obtain or shed possessions (or loved ones!). Such a memorandum is legally binding in most states, as long as it’s mentioned in your will. But even if the memorandum isn’t legally binding, it’s probably still worth doing and assuming that your loved ones will honor it.

4. A Plan for Your Pets
If you’re an animal lover, you know that pets aren’t possessions; they’re part of the family. Thus, more and more estate plans include provisions for pets. There are a few ways to incorporate pets into an estate plan, and they’re a gradation. The gold standard, albeit one that entails costs to set up, is a pet trust. Through such a trust, you detail which pets are covered, who you’d like to care for them and how, and leave an amount of money to cover the pet’s ongoing care. Alternatively, you can use a will to specify a caretaker for your pet and leave additional assets to that person to care for the pet; the downside of this arrangement is that the person who inherits those assets isn’t legally bound to use the money for the pet’s care. At a minimum, develop at least a verbally communicated plan for caretaking for your pet if you’re unable to do so–either on a short- or long-term basis.

5. A Digital Estate Plan
Even people who think they’ve ticked off all of the usual boxes on their estate-planning to-do lists may have overlooked an increasingly important component of the process: ensuring the proper management and orderly transfer of their digital assets after they die or become disabled. Just as traditional estate planning relates to the management and transfer of financial accounts and hard assets, digital estate-planning encompasses your digital possessions, including the tangible digital devices (computers and smartphones), stored data (either on your devices or in the cloud), and online accounts such as Facebook and LinkedIn. The laws around digital assets are changing quickly, and different providers have different policies/level of access. But a key first step is taking an inventory of all of your digital accounts and storing it in a secure but accessible location. You can include it as a separate sheet on your master directory, discussed above. Discuss the existence of this document with your executor, and if you have valuable digital assets (cryptocurrency, for example) you’ll want to be sure to discuss them with your attorney and incorporate them into your formal estate plan.

6. A Plan for the End of Life
If you have an advance directive, you know that it articulates your attitudes toward life-extending care. But these documents are typically boilerplate; they don’t go into great detail on these matters. If you’d like to add additional background for your spouse, children, or other loved ones who might be making healthcare decisions on your behalf, check out “The Conversation Project.” It offers a starter kit to help you clarify your thinking and discuss these matters with your loved ones.

It’s also worthwhile to spell out your wishes and any plans you’ve made for funerals, memorials, and the disposition of your body, either verbally, in writing, or both. Maybe your wishes are simply to have your loved ones say goodbye in whatever way gives them the most peace at that time; in that case, tell them that or write that down.

7. An Ethical Will
Last but not least, consider writing or recording an ethical will that spells out your beliefs and values. In contrast with a conventional will, which lays out how you’d like your financial and physical property to be distributed, an ethical will is a way to “hand down” your belief system to your loved ones. The tradition of ethical wills began in the Jewish community, but it has gained more interest across cultures over the past decade. This is a heavy assignment, so don’t too much pressure on yourself to be profound or to write an ethical will all at once. Instead, consider starting your ethical will by jotting down your beliefs as they occur to you. To help remove some of the pressure, balance light bits of wisdom (“always keep a bottle of champagne in the refrigerator so that you can celebrate happy events big and small”) with the deeper life lessons that you’ve learned.

Complete Article HERE!

“We pathologize the dead.”

Mortician Caitlin Doughty on funeral rituals and why death is often hidden away

Mortician, Caitlin Doughty.

by Jonathan Bastian

Some Native Americans have long believed that death is part of the natural cycle of life and many cultures believe the dead spirit continues to “walk on” implying the continuation of a journey rather than an end point with death. Funeral and burial rituals provide comfort and acceptance; death is embraced and revered instead of feared. What can be learned from these practices and rituals that would help make death more meaningful, and less frightening. Do rituals need to be religious to serve a purpose? KCRW’s Jonathan Bastian talks with Larry Sellers, a traditional practitioner and member of the Osage, Cherokee and Lakota tribes and Caitlin Doughty, a mortician and author of “From Here to Eternity; Traveling the World to Find the Good Death.”


The following interview excerpts
have been abbreviated and edited for clarity. 

KCRW : We heard from BJ Miller, about how we, as a society, run from death and delay it. What have you experienced?

Caitlin Doughty:What I always find fascinating about the American way of death is how successfully we’ve hidden death. Dead bodies go to funeral homes or industrialized crematories. People who are dying are hidden away in hospitals or nursing homes. Even our animals are removed from view and taken to slaughterhouses, so we don’t even know where our meat comes from anymore. So never in history has there been a society that has so successfully hidden away death, and I think that’s caused innumerable problems.

Larry Sellers: Yes, for the most part, the masses have had this thing about being afraid of death; it’s not a part of their lives, so they hide it and then they make more out of it than what it really is. And in traditional cultures, there isn’t death, there’s only a change of worlds. That you go from this world, because the human spirit never dies and you go to another world. And the dominant culture here is to make everybody afraid of death. Whereas traditional peoples, we look at it as a part of that life cycle. And it’s the transition, the “crossing over,” that’s to be celebrated.

Traditionally many years ago, the way Osage people would bury those who have “crossed” was to put them in a sitting position facing East where the sun rises, so they could greet the morning. Then they would stack stones around them. As a society we believe the community and heritage comes first, so in death, you would be willing to sacrifice yourself, so that the people on Mother Earth can continue to survive.

What about the importance of ritual and ability to navigate this process?

Doughty: What I end up focusing on is the idea that engagement right after death, specifically engagement with the dead body itself is primal, it’s timeless and it can help your grief journey so much to be able to be present with the dead body and care for the dead body because that’s what humans have been doing for tens of thousands of years in all different cultures.

The fact that we pathologize the dead body, we’ve said it’s dangerous, it’s scary, it’s filled with bacteria, it’s probably decomposing, none of which are true. We’ve made the dead body something that can only be handled by professionals for quite a lot of money, as opposed to something that can be done in your community, by the person’s wife or by the person’s child.

In fact, if the family is involved with care for the dead body, it can completely transform how they feel about the death; they can feel empowered, they can feel connected and they can feel like they were there at the very end.

Also it doesn’t have to be religious. If you feel like you’re a modern secular American, without much of a connection to religiosity or that you’ve lost it. Ritual can a-religious, if you still believe in what you’re doing and you’re doing a physical action, you can still be powerful, important, and it can represent a transition.

Sellers:Being with that body and helping that body make that transition is so important. We’ve been affected by the US law from totally practicing our culture because we’re required in large part to encase our family members in a either a metal case or concrete casement rather than a natural burial. Only a few places around the country that allow for natural burials. So if you want a natural burial, you have to go there rather than be with your relatives here. Being around that body helps you process that transition. And it helps to see that person is taken well care of by the family members and the people who were important in that individual’s life.

Complete Article HERE!

Why planning for death should start when we’re living

Dr. B.J. Miller.

by Jonathan Bastian

Death and dying are inevitable and a natural part of life’s cycle. The pandemic has brought the issue of our own mortality into sharp focus. Many people have died alone, away from family, and in the isolation unit of a hospital.  It’s not an option many would choose. Palliative care expert Dr. B.J. Miller talks with KCRW’s Jonathan Bastian about his experiences caring for those who are at the end of their lives. He says one of the big takeaways of this moment is that we should make preparations and think about our mortality when we are healthy.  

The following interview excerpts have been abbreviated and edited for clarity. 

KCRW: You’ve spent countless hours with folks that are nearing the end of their life. What do people want as they prepare to die?

B.J. Miller: Well, in general there’s a ton of individual variation. This is why the subject is so interesting and that’s where some of the joy is. For the most part people want to be at home when they die. And by home, most people mean not the hospital and not the nursing home. Dying at home is doable, especially with hospice. But again here, what I really think people mean is they want to die in familiar settings, where they’re comfortable surrounded by people they love, wherever they call home. In other words, to have a minimum of gear and machines propping them up. A lot of people find peace, in the realization that they are natural creatures and that death is a natural phenomenon. And the more they can touch into that nature, the more at peace they feel, as a rule. But some of us see ourselves as fighters and quote unquote, “when I go down, I go down swinging,” and the idea of an ICU death with desperate measures happening, is fitting, so to each their own.

But to answer your question, dying at home, dying in a more natural way, dying comfortably enough so that you can have time with people you care about. So you can think about anything you know, something besides your pain for a moment here and there. People want to be at peace with their loved ones.

The idea of closure is an invented notion. Nature doesn’t promise us closure except for the idea of birth and death. But a lot of us are just social creatures and are thinking about our legacy, what do we leave behind? So a lot of people say, I just want to make sure I’m not a burden to my family. I want to make sure my family is okay.

It makes sense because I think a lot of what’s dying is the ego and the more each of us can find a way to to love life outside of ourselves beyond ourselves, but inclusive of ourselves, the easier death is on us, the more readily we can, we can handle it.

As we navigate this pandemic, it highlights some of the breakdown in the healthcare system in dealing with death?

The last thing any of us wants to do is shame each other as we’re heading off the planet. But this is exactly why — whether it’s COVID, being hit by a bus, the idea of a sudden death, of suddenly being here and then not being here, that’s always possible — when we make this subject matter taboo — hard to talk about, and the healthcare system doesn’t make it any easier and doctors aren’t trained to talk about it — we end up kind of deferring the inevitable until it’s really too late.

So one of the takeaways right now is we should all be doing our advanced care planning, our wills, our healthcare proxy, the variable putting our affairs, we should all be thinking about our mortality, if only to make sure we are present for the life we have. These are lessons that have been in the population for eons but are easily forgotten because death is such an obnoxious topic, especially in modern society. But we can be swept away in an instant and it would be so helpful to have had these conversations with loved ones before and document our wishes, especially when we’re healthy because you just never know.

You worked at the Zen Hospice Center for a long time in San Francisco, is there a spiritual dimension that you are aware of being around death for so long?

You know, I don’t know what word I like, religion, faith, spirituality, they’re all importantly different. I believe that we are all connected not just person to person, but person to tree, person to chipmunk, person or whatever, that we’re all part of something that we can’t possibly fathom. And as smart as we are, there’s still so much we don’t know. So there’s got to be some deference to mystery, some deference to not knowing.

You can look at that void or that abyss or that mystery and project judgments or you can project a sort of a universal love. For me, I happen to believe that, in general, adjectives and qualifications are human invention. But one way or another, I look at that mystery, I feel all that connection and I see love. I see humility in all that we don’t know and yet are totally a part of.

You can imagine how much this comes up when you’re dealing with patients and families, friends, anybody at the end of life.  If I can sit with a patient and they’re in the throes of wondering what’s going to happen, maybe scared about what’s going to happen when they die, I often end up just talking with people about mystery and about not knowing and say, “Well, you know, I don’t know either, you know, I’ve been around death and dying for a lot of a lot of years and a lot of people and I still have no idea. And you know, isn’t that amazing?”

When I look up in the night sky, and I can see all these stars and light that’s hitting my eyes that left that source billions of years ago, empirically, there’s enough proof of connection among us or fascination around us. I’m coaxed into a faith that love is somewhere binding us. And even if it’s not the natural order, it’s certainly something that we inject and put love and meaning into this mystery.

And so sitting at the bedside, there’s a permissiveness at the end of life that I’ve come kind of addicted to, because if you’re with someone who’s only going to be around for a while, you can quickly go to the vulnerable place, you can quickly love someone without fear of Gosh, if I tell them, I love them, they’re gonna get expectations and you don’t have to talk yourself out of this very simple thing of loving someone.

So at the end of life, I don’t know what’s coming either but I’m gonna sit here with you and we’ll walk up to the edge of that abyss with you and I’m not going to go anywhere. And I’ll be thinking of you even after you’re gone and I love you, and we get to share this planet at the same time. Isn’t that amazing?

Complete Article HERE!