‘I don’t want to compete with this disease’

— What physician-assisted death is like for a family

Margaret Handley wrote the essay so her children understood their grandmother’s experience and to help others learn about physician-assisted dying.

By Meghan Holohan

It started with weakness and pain when walking. Then Jacqueline Shapiro had a deep lesion on her leg before she broke it, oddly, and doctors struggled to set it. The pain medications caused her to have bad reactions and her energy waned. Eventually doctors learned that the 85-year-old had lymphoma. She underwent three grueling months of surgery, radiation and chemotherapy, but it only left her exhausted and feeling worse.

“It can cause delusions and a sort of psychosis. And it just was horrible, just horrible. And it was really hard for her to get her pain stabilized,” Margaret Handley, her daughter who is an epidemiologist living in the San Fransisco Bay area, told TODAY. “If you looked at those episodes medically, they were going well, but it was just part of an escalating discomfort for her. She increasingly felt like ‘I don’t think this is a good place for me to be.’”

Shapiro worried about spending the rest of her life undergoing painful treatments that might not even cure her cancer.

“She didn’t want to be lying there dwindling while people take care of her,” Handley said.

When a palliative care doctor visited Shapiro to discuss her pain, they started talking about California’s End of Life Act. People with terminal illnesses, who meet a certain criteria, can request drugs to aid dying, according to the California Department of Public Health. Similar legislation exists in eight other states. Compassion & Choices, a nonprofit working to improve patient rights and individual choice at the end of life, recently reported that Brittany Maynard’s advocacy of “death with dignity” inspired the passage of medical aid dying laws in Washington, D.C, Colorado, Hawaii, New Jersey and Maine.

Shapiro met those requirements. Hearing about the option of medically assisted death seemed to lessen her burden.

Handley shared more about her mother’s death in an article in the Annals of Family Medicine.

“She told me right away after the doctor left, ‘That’s what I’m going to do — physician-assisted dying. I don’t want to compete with this disease — that’s not what I want to do with the rest of my life,’” she wrote. “I sat with her and my sadness and then, over the next few days, we set upon the logistics to put her right-to-choose into motion.”

While her oncologist thought there was a possibility that the cancer could go into remission, Shapiro wasn’t sure if she could endure more treatment. Then she spoke with a doctor from the physician-assisted dying group, who described how the process works. He noted that many people request the drugs but don’t ultimately go through with it. Handley felt impressed by how all three doctors acted when advising her mother.

“I don’t think that (the doctors’ input) affected her decision,” Handley said. “But it was also much better that she heard them and witnessed them doing their work and felt like she was part of the narrative, not outside of it.”

Shapiro loved nature and the forest. As a young woman, she spent her summers at Yosemite and lived in the Sierra Nevada mountains until age made a remote living situation a little tougher. She had a garden with plants from the forest and an ornery cat name, Darcy, named after Mr. Darcy from “Pride and Prejudice.” While she was sick, she worried about his well-being. Making the decision for physician-assisted death put her mind at ease about what would happen to her pet, her plants and her life. This allowed Shapiro to say goodbye to her family the way she wanted, watching nature shows and cat videos, enjoying one another’s company.

“We were lucky to know it was coming and to be able to say let’s have these moments together,” Handley said.

Handley and her brother sat with their mother, with Darcy on her lap. As Handley read the poem, “Evening” by Rainer Maria Rilke, her mom passed away.

“It was a really powerful experience to be able to sit with someone who is making this choice,” Handley said. “That was a good experience for us to share.”

Handley said she wrote the essay because she felt there were so few personal stories about what physician-assisted death is really like. She also hoped that by sharing the experience her three children would also better understand her mom’s choice and experience.

“I wanted to write down what happened with my mom’s decision-making so that they would understand,” she said. “I thought this was just adding a little more real personal experience of what (physician-assisted death) looks like in one given situation.”

Complete Article HERE!

Sacred Songs for the Dead

Women had few powers in Ancient Greece – except in death.

The picture of mourning: the Lamentation of Achilles. Vase painting, Greece, c.575/550 BC.

By Patricia Lundy

Demonstrating grief through wailing and song has long been a historic, sacred part of honouring and remembering the dead. From the Chinese to the Assyrians, Irish and Ancient Greeks, oral rituals of outward mourning were a responsibility that fell (and continue to fall) to women.

In Ancient Greece, while women may have lacked political and social freedom, the realm of mourning belonged to them. Their role in remembering the dead granted them their only position of power in a society where they possessed no autonomy. Yet this power was also believed to supersede mortal constraints, giving women the ability to do something that men could not.

The Greek funeral was composed of three parts: the prothesis, or preparation and laying out of the body; the ekphora, or transportation to the place of burial; and the burial of the body or the entombment of cremated remains. It was during the prothesis that the women began their ritual of lament. First, they cleansed the corpse, anointed it and decorated it with aromatic garlands as it lay atop its kline (bier). Once the body was prepared, scores of female relatives gathered around it to beat their breasts and tear the hair from their scalps as they sang funeral songs. They wished to communicate the awful weight of their grief in order to satisfy the dead, whom they believed could hear and judge their cries. In contrast, the men kept their distance to salute the dead, physically signifying their separation from the realm that belonged to women. Some art from the Geometric period suggests they may have joined the female mourners in writhing to the lament, though they were spared from the excruciating gesture of ripping out their hair.

The funeral song served as an extension of the physical pain women inflicted upon themselves during the prothesis. Its purpose was to communicate a cry of uncontrollable pain, a hysteric melody that was believed to be rooted in feminine emotions; thus, only women could be the vessels for this pain. In the depths of their sorrow and self-torture, female mourners in the Geometric period would have sung a melody from one of the four major funeral song categories: threnos, epikedeion, ialemos or goos. These songs were personal and meaningful to the bereaved. In her book Aspects of Death in Early Greek Art and Poetry (1979), which, through the art they have left behind, analyses how the Ancient Greeks viewed death, Emily Vermeule writes that goos was the most intense kind of funeral song. It might have been reserved for lovers or close family members, as its theme was centred on the relationship between two lives shared, the one now lost.

Leading the funeral lament was the song leader, also called the eksarkhos gooio, or the chief mourner. In early times, she was a professional mourner, but could also be the mother or close female relative of the dead. The song leader served as the liaison between those who mourned and those who had passed, guiding the bereaved through the proper course of remembrance in order to mollify the dead. As she led the female mourners in lament, she was careful to cradle the head of the corpse. Touch was necessary in order to open the ears of the dead. But once the ears were opened, the living women had to tread carefully. Not only could the dead hear funeral laments sung for them during the prothesis, they could also determine whether the presence of the living was good or malevolent. This is the reason, writes Robert Garland in The Greek Way of Death (1985), that Odysseus is advised against participating in Ajax’s funeral. Mourners entrusted their song leader with the responsibility of appeasing the dead to ensure their smooth transition into the spirit world.

As time went on, the role of female song leader would serve as the predecessor to an occult offshoot, the goes, who used song as a vehicle to transcend mortal constraints. Under the goes, funeral songs were no longer songs: they were spells, used to lure the dead back to earth. The goes was akin to a witch, due to her supernatural powers; she had even mastered the art of necromancy and could temporarily bring corpses back to life. Yet, even before the goes and the eksarkhos gooio, women in Ancient Greece had ties to the occult side of death. If the eksarkhos gooio was the mother of this occult tradition and the goes the maiden, the egkhystristriai was the crone. Before the classical period, the egkhystristriai was believed to have officiated at the burial of the body. Like an occult high priestess, her powers stemmed from the ritual of making blood sacrifices to the dead. Later, these sacrifices turned into the more modest ritual of offering libations, exemplified as Antigone pours offerings over her brother Polyneikes after she performs rites over his body.

By the fifth century BC mourning rituals had become less elaborate and deliberately reduced the importance of the female role. The number of female lamenters who surrounded the dead dwindled from scores of close relatives to only a few. Laments became more antiphonal and grew to involve men. Gestures such as tearing the hair were replaced by the symbolic gesture of cutting the hair short. These later changes suggest that the Greeks believed their dead were in less need of appeasement, eradicating the need for a song leader with supernatural inclinations. But they attempted to diminish the role that women had in the death process, thus dismantling a space in which women held dominance. In the classical period, women were relegated to the background of the funerary ritual, writes Maria Serena Mirto in Death in the Greek World (2012), because men feared it would threaten social cohesion and their desire for death to be pro patria, for one’s country. This is evident from Greek state funeral records, such as that in Kerameikos, the Athens cemetery, in which female lamenters are only briefly mentioned, suddenly peripheral to the ritual they had previously orchestrated.

The trend of removing women from the centre of death is not exclusive to Ancient Greece. While some cultures, such as the Assyrians, fought to preserve the role of female lamenters, others have been unable to do so.As Richard Fitzpatrick reported in the Irish Examiner in 2016, in Ireland, the tradition of female keeners, who wail in grief, began to die out in the mid-20th century. In the United States, male funeral directors replaced the long-standing tradition of female layers-out. Women were left behind, as the funeral directors attempted and succeeded at monetising the death industry, a legacy that continues to haunt the recently bereaved, who must deal with costly funeral arrangements.

Today, however, we find ourselves in the midst of a death renaissance, spearheaded by morticians, activists and artisans alike – a majority of whom are women. Ancient mourning rituals and traditions are resurging. Perhaps the role of the female song leader as a spiritual caster of spells will find its way back, too.

Complete Article HERE!

Why Arun Shourie concludes that the ultimate preparation for death is simply love

The former Union minister and veteran journalist’s latest book, ‘Preparing for Death’, is both a contemplation of and an anthology on death

by Pratap Bhanu Mehta

Arun Shourie is an unflinching seeker. He has an exemplary ability to face the toughest questions. After a bracing meditation on the problem of suffering in Does He Know a Mother’s Heart (2011), Shourie now turns to Preparing for Death. There used to be a joke that the purpose of literature is to prepare you for the good life, while the purpose of philosophy is to prepare you for the good death. But it is hard to understand our own extinction. Broadly speaking, two diametrically opposite views are invoked to reconcile us to death. One is that we don’t really die; in some form, through an incorporeal soul or something, we continue to exist. The other unflinchingly accepts that we just are evanescent matter and nothing else. Both approaches address the question of dying by simply saying “there is nothing to it.” There is something to this strategy, but it cannot make sense of the significance of life. It seems we can either make sense of life or of death, but not of both.

Shourie’s book takes a brilliantly different pathway. The book has three distinct themes. The first, the most powerful and meditative section of the book is not so much about death as the process of dying. He documents with detail, “great souls” experiencing the often painful dissolution of their own body — the Buddha, Ramkrishna Paramhansa, Ramana Maharshi, Mahatma Gandhi, and Vinoba Bhave, and, as a cameo, Kasturba. All of them give lie to Sigmund Freud’s dictum that no one can contemplate their own death. But what emerges from these accounts is not so much the conclusion that they all faced death unflinchingly; most of them have a premonition. It is also not about capturing the moment where the good death is leaving the world calmly. It is rather what the suffering body does to consciousness, all the memories and hard decisions it forces on us.

But the relationship between the body and consciousness goes in two different directions at once. On the one hand this suffering is productive: consciousness works through this pain. On the other hand, even the most exalted soul does not escape the utter abjection of the body. The most poignant moment in this section is not the calm and plenitude with which these exalted souls face death; it is the moments where even the most powerful souls are reduced to abjection by the constraints of the body. The only one rare occasion where Ramana Maharshi ever loses his cool is in his now utter dependence on others for most basic bodily functions. The problem of dying is not that you cannot ignore the body; it is that the body does not ignore you.

The second theme of the book is to take a sharp scalpel to false comforters of all religions and philosophies that promise the everlasting soul, or the preservation of bodies only to subject them to torment in hell. This metaphysical baggage makes dealing with death harder and is a total distraction. This section is less generous in its interpretive sympathies. The third theme of the book, interspersed in various parts, is about the discipline of dealing with your own body as it is in the process of dying. The book impressively marshals a variety of sources, from the Tibetan Book of the Dead, with its incredible imaginative exercises that make you take in the whole of existence, to Jain sources of Sallekhana, and various meditative techniques to inculcate a certain kind of mindfulness. But mostly one gets the sense that the ultimate preparation for death is simply love, something that can endow the evanescent moment with significance.

But this is a seeker’s book. It is in parts profound probing, honest but not dogmatic. Its immense value comes from the fact that the book is both a book and an anthology on death, with extracts from not just the words of those experiencing the process of dying, but an astonishing range of sources: from Fernando Pessoa to Michel de Montaigne, from yoga to the Tibetan Book of the Dead. For the politically inclined, there is an ambivalently revealing account of the Prime Minister’s visit to Shourie while he was in the ICU. All throughout, the book is laced with judiciously selected poetry: the startling moment where Gandhi recites the Urdu couplet to Manu: Hai baha- e-bagh-e duniya chand roz/ Dekh lo iska tamasha chand roz, a register you might associate more with Guru Dutt than Gandhi. There is a lot of Kabir, of Basho poetry and haikus. One stunning one: Circling higher and higher/At last the hawk pulls its shadow/From the world.

This haiku caught my attention because I happened to be reading a stunning essay by Arindam Chakrabarti at the same time, “Dream, Death and Death Within A Dream”, in Imaginations of Death and the Beyond in India and Europe (2018), a volume edited by Sudhir Kakar and Gunter Blamberger, that reads as a great philosophical complement to this one. That volume has a powerful piece by another brilliant philosopher, Jonardan Ganeri, on illusions of immortality that deals with a source Shourie cites at length: Pessoa. Chakrabarti’s essay ends with the insight of Yoga Vashishtha: To be born is to have been dead once and to be due to die again. Shourie is perhaps right: Can we really unravel what it means for the hawk to pull its shadow from the world? Does the shadow reappear if it flies lower?

Complete Article HERE!

Living the Ancient Greek Death

One needs to put oneself in the sandals of a dying Greek to understand the mind frame of the ancient Greeks and to understand why they did the things that they did. Also, one needs to live an ancient Greek death following all the rites of passage and the burial laws.

The first rite of passage, or prothesis, means laying out of the body.

By Robert Garland, Ph.D.

Putting Oneself in the Sandals of a Dying Greek

The ancient Greeks held certain ideas about death. One of the most characteristic motifs that people find on ancient Greek tombstones is the handshake between the living and dead. Both figures invariably exhibit a dignified calm. That’s what Greek tragedy is all about—looking death squarely in the eye. As a Greek, they knew that terrible things happen; and they knew, too, that by confronting them head-on, they’d be able to deal with them and get on with life. One could posit that the Greeks got it just right.

But one needs to put oneself in the sandals of a dying Greek to understand it. It’s an unpleasant thought, but there’s no escaping it if one wants to fully experience the other side of history.

The Role of a Physician in Death

Let’s assume one is dying in one’s home, surrounded by one’s relatives, including young children. There won’t be any physician at hand to give painkillers.

A physician may have offered treatment in the earlier stages of sickness, but once it became inevitable that there could only be one outcome, the medical profession had nothing to offer anymore.

It’s also extremely unlikely that a physician would be called in to put one out of one’s misery by euthanasia, a coined word of Greek etymology meaning ‘good death’, but which has no ancient Greek equivalent. In fact, the Hippocratic Oath, which was probably widely adopted, enjoined upon those physicians who took it “not to administer a poison to anybody who asked for one and not to propose such a course”. So let’s hope that one’s final illness is short and painless.

The Role of Gods in Death

The poet Keats has a wonderful line in Ode to a Nightingale: “I have been half in love with easeful death”. The Greeks conceived of easeful death in the form of the God Apollo, who came to strike them down with his so-called ‘gentle arrows’. That’s the best that he or any other of the gods had to offer. They certainly didn’t have any consolation to give someone.

In Euripides’ play the Hippolytus, when Hippolytus is dying, the goddess Artemis, to whom he has devoted himself exclusively all his life and with whom he’s had a very close relationship, bids him farewell. She explains to him that it’s not lawful for a deity to be present at the death because the pollution that a corpse releases would taint her.

The one god who may have taken some slight interest in the fate of the dying is the healing God Asclepius. When Socrates passes from this world to the next in Plato’s dialogue the Crito, he has this to say, “I owe a cock to Asclepius. See that it’s paid.” Cocks were sacrificed to Asclepius. Socrates may be indicating that Asclepius eased his passing, although it’s possible, too, that he’s merely suggesting philosophically that death is a ‘cure’ for life.

The First Rite of Passage: Prothesis

in ancient Greece, as soon as one died, the women in one’s family began keening and ululating so that everyone in the neighborhood knew of the individual’s demise. It was the women, too, who took charge of one’s body and prepared it for burial. They closed one’s mouth and eyes, tied a chin strap around one’s head and chin to prevent the jaw from sagging; they washed the whole body, anointed it with olive oil; they clothed the body and wrapped it in a winding sheet, leaving only one’s head exposed.

Then they laid the body on a couch with one’s head propped up on a pillow and one’s feet facing the door. After getting all this done, they sang dirges in one’s honor.

This is the scene that is depicted on the very earliest Greek vases with figurative decoration. It’s called the prothesis, which literally means the laying out of the body. It represents the first stage in the process that will take one from this world to the next, ‘from here to there’, as the Greeks put it. Meanwhile, relatives and friends would call at the house and join in the grieving.

The Second Rite of Passage: Ekphora

The second rite of passage is the ekphora. Ekphora means literally ‘the carrying out of one’s body’—specifically from one’s home to one’s place of burial. According to Athenian law, the ekphora had to take place within three days of one’s death, although in hot weather it’s likely that it would have taken place much sooner. The ekphora had to take place before sunrise so that it wouldn’t create a public nuisance.

If one was wealthy, one’s body would be transported in a cart or carriage drawn by horses. This scene is also depicted on the earliest vases with figurative decoration. Professional undertakers might also be employed to bear the corpse and break up the ground for burial. These professionals were known as ‘ladder men’ klimakophoroi, because they’d lay one’s body on a ladder, which they carried horizontally.

If professional undertakers were employed, they wouldn’t have any physical contact with the family members before this phase. The Greeks would have been shocked and appalled by the idea of handing over one’s body to professionals to prepare it for burial.

The Third Rite of Passage: Burial

It was one’s relatives who conducted the burial service. No priests were present either. Priests were debarred for exactly the same reason that Artemis absented herself from the dying Hippolytus, so as not to incur pollution. Because if they incurred pollution, they might transmit it to the gods.

Absolutely nothing is known about the details of the burial service. Truth be told, it’s not even known if there was a burial service as such. If any traditional words were spoken, they were not recorded. Both inhumation and cremation were practiced, although cremation, being more costly, was seen as more prestigious. If one was cremated, then one’s relatives would gather the ashes and place them in an urn, which they then would bury along with the grave gifts.

The commonest grave gift was pottery. In fact, that’s why so many high-quality Greek vases have survived intact—because they were placed intact in the ground.

Over time, however, the Greeks became more stingy. Chances are, if one died in the 4th century B.C., all one would get is a couple of oil flasks known as lêkythoi filled with olive oil—olive oil was regarded as a luxury item. Some Greeks, however, were so stingy that they purchased lêkythoi with a smaller internal container to save them the expense of filling the whole vase with oil. Supposedly, they thought the dead wouldn’t notice.

As soon as the filling of the grave was done, they’d erect a grave marker over it. After completing the third and final rite of passage, all the mourners would return to the grieving home for a commemorative banquet.

The Burial Laws

Pottery was one of the most common grave gifts for the dead.

Since one’s corpse was regarded as a source of pollution—the Greek word for the pollution is miasma, which means much the same in English—one had to be buried outside the city walls. In the ancient Greece, burial within a settlement was extremely rare after the 8th century B.C. The same was true of Rome. The earliest Roman law code, the Law of the Twelve Tables, dated 450 B.C., contains the provision, “The dead shall not be buried or burnt inside the city.”

It is not certain, but the origins of the belief in pollution may be connected with a kind of primitive sense of hygiene. Dead one’s relatives and anyone else who had come into contact with the corpse were debarred from participation in any activities outside the home until the corpse had undergone purification.

Reintegration into the community for mourners didn’t take place until several weeks after the funeral. One’s relatives also had to take measures to prevent the polluting effect of one’s corpse from seeping into the community. That included providing a bowl of water brought from outside the house so that visitors could purify themselves on leaving.

Common Questions About Living the Ancient Greek Death

Q: What are the three stages of an ancient Greek funeral?

The three stages are the laying out or the prothesis, the funeral procession or the ekphora, and the burial or the Interment.

Q: How did the Greeks honor the dead?

Greeks honored the dead by following the three rites of passage, by building the tombs in Ceramicus, the Potter’s Quarter, and by offering the grave goods.

Q: How did Greeks prepare for the afterlife?

Greeks prepared for the afterlife by following the three rites of passage and offering the grave goods.

Q: What was the burial law in ancient Greece?

According to the burial law in ancient Greece, one had to be buried outside the city walls.

Complete Article HERE!

The Grief That Is, The Grief that is Coming

I have smelled grief on the air for years. The ache of loss, of losing, of having lost.

by Irisanya Moon

As the northern hemisphere moves into the winter, the wind blows in the reminder that so much will be lost. I’ve seen the posts of people I don’t know, but who are close to those I do, sharing stories of family members getting sick or dying of COVID.

It’s getting closer. Faster. The air is thicker with uncertainty.

Of realization that there is no one coming to save us from this virus.

Because there is no quick fix. There is no perfect protection.

(I know this is grim.)

I know these times are more dangerous because of the fear. I have seen it cause even the most steady folks to sway. Some to risky choices. Some to conspiracy.

I know I am in a moment that history will look back on and point out all of the wrongs.

But this is not a measured conversation where I can hide behind lovely words.

There are people dying.

Not Enough Space for the Names

I was on a social media page and someone talking about an altar with candles for the dead on their heart. And that there wasn’t enough space for all of the candles.

After all, more than 250,000 in the United States (and many more by the time this is posted) requires a large space. An impossibly large expanse of holding.

I want to light candles for all of you. I want to brighten this time with your names.

And I want to hold space for the ones who have watched. Watched loved ones die. Said goodbyes over video. Begged to be in the room only to be turned away.

Safety. Not you too.

What is Coming (Soon)

In the beginning, I read a lot about anticipatory grief. The knowing that loss is coming and not being able to stop it.

My heart remembers when my dad was diagnosed with COVID. And the days of blurry, fuzzy thinking. Trying to make decisions as a family about what we would do if…

Touch and go. Faith and fear.

Prayers. Offerings. Outbursts.

I have a stubborn heart, I know. I have clung to believing people are good overall. They will look out for each other. I’ve seen it. I have relationships that have proven it.

But when I look outside my carefully curated community…

I weep.

I am likely not sharing anything that hasn’t been said. I know there are many more that feel this way. Alone. Helpless. Quietly screaming.

Arguing with ‘friends’ on Facebook doesn’t help. Posting the millionth meme about wearing masks doesn’t ease the tension. Staying home only gives more space for the feelings to become louder.

There is grief around the corner. There is grief in the hallway. There is grief in the pillow underneath my head at night.

Because it is everywhere.

Building a Relationship with Grief (Before)

Whether you have lost or not, whether you have been impacted or not, the grief will be a tsunami. I have been holding back my own waves because I don’t know where they will crash. Into you? Into me? Across the yard?

I have taken to sitting with grief now. I see it as an unscreamed scream. An unhugged hug. The empty place into which love pours and pours and pours.

I sit and I ask grief what it needs.

I have an altar to grief. Where I sit. Where I have an amethyst. Where I have bones.

My heart holds an altar too. Memories live there.

I sit at the altar. Sometimes, I weep. Sometimes, I am silent. Sometimes, I sing.

Sometimes. Nothing comes. Time between time.

I write poems to grief. I write letters.

Even when the words feel empty or insignificant.

The Arrival of Grief

And I realize I am preparing for grief’s arrival. All of the ways I have pushed it back, saying that since I can’t grieve in community, I will be patient.

I will wait. I must wait.

It is the thing these moments require.

The space before.

But there are a lot of echoes waiting to be screamed screams.

I imagine you have come here for answers. For solutions. For spells. For prayers.

Me too.

I just show up for it. I make time for grief. Just as I would for any other relationship.

Just as I would for any other precious moment.

Again and again.

What do you need, grief?

What do you ask?

What do you ask of me?

I am not ready.

But sit beside me.

Tell me everything.

***

How are you preparing?

Complete Article HERE!

How Jews and Muslims are burying their coronavirus dead

By Daniel Burke

The women gently pour purifying water for the woman in the coffin. A soul on the threshold deserves the utmost care.

When the ritual concludes, the body is ready for the earth, the soul for the afterlife.

But first the women, members of a Jewish burial society in Pittsburgh, must sing a final prayer.

They press the Mute button.

On Zoom their voices refuse to ring as one, so one singer takes the lead while the undertaker, who is Catholic, wraps the body in simple white shrouds.

D’Alessandro Funeral Home & Crematory occupies a building that has cared for the deceased and bereaved in Lawrenceville, Pennsylvania, since 1897. But this — a Catholic funeral director participating via Zoom in a centuries-old Jewish tradition — is likely a first, said Dustin D’Alessandro, the mortuary’s supervisor.

It’s preferable to perform the ritual in person, said Malke Frank, founder of New Community Chevra Kadisha of Greater Pittsburgh.

But many members of the burial society are elderly and fear entering a funeral home before there is a vaccine for Covid-19, the deadly illness caused by this coronavirus. Like so many other events during this pandemic, the taharah, the name for the ritual, is performed virtually, with a bit of ingenuity and help from undertakers.

While Frank and her fellow volunteers visualize washing and drying the body, D’Alessandro walks with them through the ritual step-by-step.

“We consider them partners in what we do,” said Frank.

Ancient rituals have been forced to change

Religious rites evolve over time, said David Zinner, president of Kavod v’Nichum, a national group for Chevra Kadishas, which is Hebrew for “sacred society.”

The resurgent pandemic, which has hammered the US with new urgency in recent weeks, has sent that evolution into hyperspeed.

While public health officials are still learning about how Covid-19 spreads, the CDC has said “it may be possible” that people could become infected by touching the body of someone who has died of the virus.

“We went from caring for a person’s body the way we have for four hundred years to suddenly not being able to do that anymore,” Zinner said.

The coronavirus has changed so much about how we live, it was inevitable that it would alter how we die as well. The graveside gatherings, shoulder-to-shoulder prayers, consoling hugs and timeworn rituals have been canceled or curtailed for fears of contagion.

Orthodox Jewish men move a wooden casket from a hearse at a funeral home on April 5, 2020 in the Brooklyn borough of New York City.

But grief abhors a vacuum. So traditions have been adapted, as clerics turn to emergency measures prescribed in their religious laws. That’s especially true of rituals, as in Judaism and Islam, that rely on touch and intimacy with the deceased. In some instances, funeral home directors and burial societies across the country are crossing religious lines to help perform the sacred rites of passage.

D’Alessandro, who has participated in 12 burial purifications, said Frank’s society taught him about the meaning behind the rituals, imparting a sense of their importance to the living and the dead.

“I’m glad they’re allowing me to do it, despite not having a background in Judaism,” said D’Alessandro. “It’s just an incredible thing to be a part of.”

He’s insisted on providing full Islamic burials

When Covid-19 raged through New York City earlier this year, Imtiaz Ahmed was proud that his was one of the few funeral homes that still offered ghusl, an Islamic purification ritual performed on the recently deceased. As in the Jewish tahara, the body is cleansed, usually by a close family member and burial expert, then dressed in simple white robes before it is buried.

It was quite a turnaround for the Pakistani-American, who used to drive a cab and was squeamish about touching dead bodies. Now, Ahmed says, he has a clear mission.

“Once Covid started I realized that I had made the right decision,” said Ahmed, 39, “because people need my help.”

A casket of a Muslim man who died from what was believed to be the coronavirus is prepared for burial at a busy Brooklyn funeral home on May 9, 2020.

But some of the employees at his Al-Rayyan Funeral Services in Brooklyn’s “Little Pakistan” neighborhood were more reluctant. Several quit, citing health conditions or fear of contagion, Ahmed said.

The Centers for Disease Control recommends taking precautions with rituals that involve touching the dead and urges funeral homes to suit up with proper protective equipment. It is not yet known whether dead bodies can transmit the disease, according to the CDC.

The Fiqh Council of North America, a group of scholars who offer opinions on Islamic law, said there are several alternatives to touching the bodies of Covid-19 victims. In a “worst case scenario,” the council said, Muslim leaders should adopt a different method of cleansing, using sand instead of water and not opening the body bag.

Others, such as Ahmed in Queens, consider Covid-19 victims martyrs, following the Prophet Muhammad’s teaching about believers who die in plagues.

“We believe that God forgives you for whatever you are not able to do,” said Yasir Qadhi, dean of academic affairs at the Islamic Seminary of America in Dallas and a member of the council of scholars. “If the government is asking you not to wash deceased bodies, as psychologically painful as that might be, it will not affect the deceased.”

Still, many Muslims feel guilty for not being able to provide full Islamic burials, said Dr. Edmund Tori, a medical doctor and president of the Islamic Society of Baltimore.

“When you modify the prayer, you are messing with something that is very, very dear to people,” said Tori, who said his society spent several months educating the community about changes to religious practices because of Covid-19.

Muslims in Baltimore were nearly as upset about alterations to the funeral prayers. In Islam, the funeral prayers, called janazah, are a communal obligation and typically draw large crowds to mosques.

Muslim funeral homes and mosques have tried to accommodate mourners by holding the prayers outdoors, in parking lots or other open spaces hospitable to social distancing.

But the desire and obligation to attend the prayers are so great, Tori said, that the Islamic Society of Baltimore has stopped sending funeral notifications — or sends them only to a small group of people close to the deceased.

When the architect of the Islamic Societies campus died of Covid-19, Tori said, leaders kept the news quiet, leading to some upset feelings.

“Let’s just say people were not happy,” said Tori. “Everyone wanted to be there. It took a lot for the community not to come.”

This group provides ‘midwives for the soul’

Zinner, the president of the national group for Chevra Kadishas, said the risks are too high for Jewish burial societies to perform the ritual purifications in person.

The live people in the room, not the deceased body, pose the greater danger, he said. Taharahs are often performed in small rooms, with people working and singing in close proximity.

“We have to recognize that the risk is high,” Zinner said, “and we have to wait until it’s reduced.”

Instead, Zinner recommends “spiritual taharas” like the virtual service in Pennsylvania.

But the Chevra Kadisha of Greater Washington, near the nation’s capital, is continuing to conduct in-person purification rituals, said Devorah Grayson, leader of the women’s section. (Women wash and dress women; men do the same for men.)

Grayson said her society has consulted with the National Institutes of Health and CDC and volunteers wear masks, face shields, two gowns and pairs of gloves, rain boots and disposable shoe coverings. Still, 35-45% of the society’s volunteers will not perform the ritual in person.

Grayson compared participating in the ritual to going grocery shopping in the pandemic.

“The first time I did it,” she said, “it was terrifying.”

But Grayson, who belongs to the Orthodox strand of Judaism, said she feels a holy obligation to help Jews on the threshold between this world and the next. One name for burial society volunteers is “midwives for the soul.”

When souls meet God, Grayson said, they should be dressed with dignity — pandemic or not.

And so, the volunteers will continue to perform the rituals. They have survived plagues before.

When the body is properly prepared, Grayson will help place it in the coffin, adding a little soil from Israel, and softly close the lid. The midwife’s job is over, and now the soul’s must begin.

Complete Article HERE!

The “good death” revolution

—Companion animal euthanasia in the modern age

Home euthanasia sets a peaceful, more relaxed tone.

A good death is achieved by advocating for, and acting on, what is safest for the pet, what is most meaningful for the caregiver, and what will nourish the veterinary team

By Kathleen Cooney, DVM, CHPV, CCFP

Animal euthanasia has come a long way in the past 15 years. With the increased attention given to the human-animal bond, particularly during COVID; the emotional complexity of animals; and the recent and welcomed focus on veterinary wellness, the importance of a good death has risen to center stage. In forward-thinking veterinary practices, the euthanasia appointment is no longer an unpleasant burden in the day, but rather a rare gem of connectedness and intimacy so many of us look for in our professional lives. It provides teams the chance to slow down, to listen to stories, to take deep breaths in quiet reflection in an otherwise chaotic schedule. Euthanasia, while sad and heartbreaking, can lead to rich personal satisfaction when performed well. When love is at the heart of our work, the veterinary profession finds peace, even when life is lost.

Good euthanasia has evolved past the simple “one step” of giving an injection. It orbits around consistent components such as the right timing, compassionate staff, skillful techniques, and loved ones gathered close. The focus has been shifting to ensure the pet’s last moments are comfortable and peaceful, rather than just getting it over with as soon as possible—quality over quickness, in most cases. When it comes to euthanasia, if it’s worth doing, it’s worth doing right, especially since there are no do-overs.

To understand the scope of the “good death” revolution, we need to explore some key game-changing influences that have brought about the shift. The first worth mentioning is the attention paid by the American Veterinary Medical Association (AVMA) and other governing bodies to euthanasia techniques and animal welfare. Numerous revisions have been made to AVMA’s Guidelines for the Euthanasia of Animals, most recently in 2020. The document highlights the value and significance of proper technique choices and the ethical considerations we all must weigh, regardless of the species in question. Are they perfect? No, but they are extremely well-thought-out and closely match peer-reviewed literature. They will improve as research progresses and as society dictates.

A second influencer then has to be society’s demand on veterinary professionals to deliver a death worthy of the life itself. It is well understood pet owners largely view their animals as family members or loving companions. As evidenced further on in this article, loving pet owners regularly view the euthanasia appointment as a modest funeral. More and more are seeking those special touches that pay added respect for their companion.

As a home-euthanasia specialist, I’ve had many families over the years attend the euthanasia of their pet wearing suits and ties. Even though no one would see them, they dressed up to honor the life and the loss. Jessica Pierce, PhD, bioethicist and purveyor of the good death revolution, advocates for what she refers to as the sixth freedom: the freedom to die a good death. She adds this freedom to the already well-known five freedoms of animal welfare. “A good death is one that is free of unnecessary pain, suffering, and fear; it is peaceful; and it takes place in the presence of compassionate witnesses. It is, above all, a death that is allowed its full meaning.” The euthanasia of a family pet is significant and for many, will be their first experience with death.

A third major influence was/is the recognition by many in the veterinary profession that death needed to be more meaningful. The kind of experience we are talking about here is one that leaves the entire veterinary team feeling they provided the best medicine possible and supported the client throughout. Approximately 20 years ago, a small number of veterinarians and technicians throughout North America found just how enriching full devotion to the euthanasia experience can be. They shifted their appointments to focus on the bond as much as the act of euthanasia itself.

Early adopters had numerous things in common. They:

  • Took time to preplan and provide highly individualized care
  • Increased euthanasia appointment times
  • Offered home services
  • Provided sedation or anesthesia to all pet patients
  • Elevated bereavement support

In return for these specialty touches, clients showered them with thank you cards and told other pet owners about the wonderful care they had received. Through eventual collective sharing of their successes in advanced euthanasia work, other veterinary professionals joined in and the modern revolution began. Since 2011, at least seven books have been written focusing entirely on companion animal euthanasia (or contain chapters on the subject), more end-of-life care guidelines are available, and the number of pet bereavement organizations has skyrocketed. Today, there are more and more veterinarians specializing in euthanasia work, many of which offer animal hospice services as well. Animal hospice is a philosophy of care aimed at providing emotional and medical support for the dying pet and caregivers. As of early 2020, the International Association for Animal Hospice and Palliative Care (IAAHPC) touts more than 800 members, a number sure to grow in the coming years.

Have you ever thought about how much really goes into a euthanasia appointment? If you start to explore all the components of a good death experience, it’s no wonder euthanasia appointments are lengthening.

Here is a list of 14 essential components of companion animal euthanasia as developed by the Companion Animal Euthanasia Training Academy (CAETA).* Spelling out “good euthanasia,” each aspires to minimize stress for the pet, provide emotional support for the caregiver, and streamline the actions of the veterinary team.

G: Grief support materials provided
Examples: Printed pet loss guides, books, or direct links to online resources.

O: Outline caregiver and pet preferences
Examples: Talk about what’s important to the caregiver and pet. Match what they need.

O: Offer privacy before and after death
Examples: Make sure a family has time to be alone with their pet if requested.

D: Deliver proper technique
Examples: Always use the most efficient and appropriate technique based on the pet’s health and available supplies.

E: Establish rapport
Examples: Slow down and emotionally connect with the caregiver and pet before proceeding.

U: Use of pre-euthanasia sedation or anesthesia
Examples: Sleep before euthanasia reduces anxiety and pain, and increases technique options.

T: Thorough, complete consent
Examples: Every euthanasia must be properly documented in records.

H: Helpful and compassionate personnel   
Examples: Engage staff to assist who are naturally empathetic. The use of a “euthanasia attendant” is strongly encouraged (more about this later).

A: Adequate time
Examples: Slow down, block out enough time to complete all 14 components.

N: Narrate the process
Examples: Describe what each step of the process looks like, being mindful to keep language simple and uncomplicated.

A: Avoid pain and anxiety   
Examples: Be gentle when handling the pet, use sedation whenever possible, and go slow to reduce anxiety.

S: Safe space to gather   
Examples: Consider using a quiet room in the hospital or performing the euthanasia at home.

I: Inclusion of loved ones
Examples: Talk to caregivers about who should to be there, including other household pets bonded to the one being euthanized.

A: Assistance with body care   
Examples: Preplan with families around what’s important to them and carry out their wishes as if the pet were your own.

In addition to veterinarians carrying out the medical act of euthanasia, vital support staff help ensure everything goes well. Empathetic veterinary technicians, veterinary social workers, assistants, receptionists, and grief support personnel work together to ensure the pet is Fear Free and the client is carefully looked after. CAETA advocates for use of what it calls the euthanasia attendant. This person is responsible for guiding the family unit through the appointment from beginning to end. While many people may be involved in the pet’s care, one consistent person increases the likelihood that everything flows smoothly.

If you’ve been watching for change, you’re sure to have noticed the increase in specialty mobile euthanasia services around the world. According to online directory In Home Pet Euthanasia, nearly 600 mobile services have been listed since 2009 as providing home euthanasia services in Canada, the U.S., and England. Nearly 80 percent specialize in euthanasia work or the broader field of animal hospice, including euthanasia services. The shift toward home euthanasia is well-founded and necessary for many families. Pets feel safer at home. And for loving owners, being at home for their pet’s euthanasia provides them privacy and reduces the challenges of driving and interacting with others while in the midst of grief.

A good death is achieved by advocating for, and acting on, what is safest for the pet and what is most meaningful for the caregiver.

Home euthanasia has proven extremely rewarding work for those who offer it. It’s also gaining in popularity, with one service reporting its team of veterinarians assisted upward of 50,000 pets in the home setting in 2019. That’s an impressive number and indicates the trend of home euthanasia is here to stay.

Like any other progressive movement, advanced euthanasia did not happen overnight. And there are lingering obstacles that continue to stifle necessary change. Number one is the old paradigm that if it’s not broke, don’t fix it. It can be hard for veterinary teams to make lasting change around euthanasia. Reshaping a hospital’s culture takes time and commitment, but it can be done and done well.

Consider the following steps to create lasting change:

  • Dedicate one month a year to euthanasia-related discussions
  • Get everyone’s input on desired improvements
  • Create a euthanasia manual and refer to it regularly
  • Hold euthanasia rounds to review successes/challenges
  • Have multiple team members obtain advanced euthanasia training

These days, the veterinary profession recognizes the value of appropriate self-care. In this respect, self-care with regard to euthanasia begins long before the appointment. It is becoming standard practice to discuss a veterinary team member’s professional limits around euthanasia. North American Veterinary Community (NAVC) and the Human Animal Bond Research Institute (HABRI) human animal bond certification program focuses on this concept in its euthanasia module. It describes how veterinary teams should take time to determine who enjoys (yes, enjoys) euthanasia work, to write down how many euthanasias one can help in a day, week, etc., and how the team plans to practice self-care. Examples include team outings, fun food days, and setting limits on the amount of time worked in a day. The likelihood of compassion fatigue is high if care is not properly taken from the onset of euthanasia-related work.

As far as we’ve come, there is always room for growth. New techniques, improved euthanasia education opportunities, and better client support tools are on the horizon. We continue to hone our skills around gentle animal handling and pay increased attention to where we gather for euthanasia. This has never been truer than during the COVID pandemic. Veterinary teams have shifted the delivery of care, ensuring euthanasia remains an essential procedure. Creative approaches to preplanning, social distancing, technique selection, and appointment timing have played vital roles in protecting the human-animal bond. The veterinary profession dealt with these necessary modifications swiftly and compassionately. And it’s important to mention that while this article has been focused on euthanasia, death is a process, not always just a moment in time. Good death also refers to the meaningful journey leading up to death, be it natural or via active euthanasia. In the words of Benjamin Franklin, “Well done is better than well said.” To help the good death revolution flourish, we must act accordingly. A good death is achieved by advocating for, and acting on, what is safest for the pet, what is most meaningful for the caregiver, and what will nourish the veterinary team. If you haven’t already, how will you join the revolution?

Complete Article HERE!