Why Cannabis For Palliative Treatment Is A Better Choice Than Opioids

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By Prakash Janakiraman

Most treatments are meant to heal, but some are for palliative care (end of life care) in terminally ill patients. Palliative care is to provide symptomatic relief from a chronic and serious illness, and to reduce the risk of developing co-morbidities and also to improve the patient’s quality of life. The aim of the palliative care is not to treat or cure the underlying disease, but to treat the bothersome symptoms of the disease. Some of the illnesses that may utilize palliative care treatments include cancer, HIV/AIDS, ALS, multiple sclerosis, etc.

Finding a proper and safer course of treatment (long-term drug safety) is one of the main challenges being faced by palliative care practitioners. The goal of the drug regimen is to alleviate the symptoms as well as to mitigate the adverse events of these drugs. For palliative care of cancer patients, opioid analgesic is the prime choice of physicians, but it can cause serious harm – or even fatal events – in the long run.

The therapeutic potential of cannabinoids to treat sleep problems, pain and anorexia might play an important role in palliative care. Cannabinoids promote analgesia and inhibit inflammation via endogenous signaling, along with other benefits such as neuroprotection and anti-cancer activity, which are significant for terminally ill patients. In cancer patients, exogenous cannabinoids act synergistically with endogenous opioids and provide pain relief, opioid-sparing benefits and reduce opioid dependence and tolerance threshold. Cannabinoids may have palliative benefits not only for cancer patients, but also in neurodegenerative, HIV/AIDS and chronic pain patients. Despite these benefits, the use of cannabinoids in critical and palliative care patients remains controversial.

According to DEA classification, cannabis is a Schedule I drug that is hazardous and without any medicinal value. Most cannabis strains do not exceed 20% THC, whereas prescription drugs, such as Dronabinol, has a 100% THC-like substance, which has been classified as Schedule III drug. Naturally occurring cannabis has several ingredients that augment the treatment benefits and negate the adverse events. However, this is not applicable in synthetic, single compound cannabinoid formulation. To reduce opioid-related morbidity/mortality and improve palliative care in terminally ill patients, considering the cannabinoids as a mainstay pain management drug is the critical need at the moment.  

The risk-benefit profile of cannabinoid-based medicine greatly depends on the drug formulation and route of drug delivery.

Problems Associated with Palliative Care

Opioid overdose-related deaths are rising across the world and in the United States. Increased availability of synthetic opioids worsens the overdose mortalities, and most of the cases are due to misuse or accidental exposure. The widespread expression of mu-opioid receptors in the brainstem leads to increased binding of opioids, which also controls the respiration and is the cause of opioid overdose mortality. Overdose opioids bind with these mu-opioid receptors, which results in the suppression of breathing and death. Long-term opioid treatment also leads to development of tolerance, and the patient often requires incremental dose increases for better pain management. Although, mu-opioid antagonists, such as naloxone, are available to reverse overdose, it must be administered within few minutes of overdose crisis, which is not always possible. In addition to opioid tolerance, opioid dependence or addiction can develop during palliative care. Opioid addiction is a serious, relapsing and chronic neuro-psychiatric illness that requires long-term treatment for recovery.

The complete symptom burden of palliative care patients is poorly understood and opioid treatments may add up to other problems, such as severe constipation and prescription of laxatives to relieve constipation. According to a large assessment study that involved 50,600 Caucasian cancer patients who were on opioid therapy as palliative care, approximately 12% of patients reported moderate or severe constipation at the first assessment, and nearly 19% patients reported the same during the last assessment. All patients were on opioid therapy that resulted in moderate to severe constipation. Prescription of laxatives to treat the constipation is likely in these patients. The goal of the palliative care treatment is to relieve the symptoms, if not to mask the agonizing pain in palliative care patients including terminally ill cancer patients. Opioid therapy appears to be worsening the problems by causing/increasing distressing symptoms that require further treatments, which is undesirable and reflects the complexity and quality of palliative care treatment.

Why Cannabinoids Are Better Than Opioids In Palliative Care

While healthcare practitioners are in dilemma about prescribing medical cannabis for illnesses, the use of medical marijuana for palliative care is trending upward. Medical cannabis significantly reduces the use and dependence of opioids and also opioid overdose-related death. According to a study by RAND Corporation, there is a plausible link between the legal medical marijuana dispensaries and a reduction in opioid-related deaths in those areas. The study compared the rate of opioid-related deaths in states with and without legal marijuana dispensaries. As reported by the study, a lower rate of opioid-related mortalities (16-31%) and fewer reports of hospitalizations (28-35%) for related treatments were observed in states with medical cannabis dispensaries, compared to states without medical cannabis dispensaries. Patients who obtained treatment without legal intervention (penalized due to illegal substance use), further decreased the rate of hospitalization (up to 53%). The duration of the presence of legal marijuana dispensaries were also found to be related with the decline in opioid-related morbidities and mortalities.

Palliative care patients can easily obtain prescription medical cannabis from these legal dispensaries to reduce their reliance on opioids, prevent the opioid-related problems and also for better management of their symptoms. According to Nora Volkow, Director of the National Institute of Drug Abuse, the evidence about the efficacy of cannabinoids is strong and cannabis could ‘provide a powerful new tool’ to combat opioids and their related problems.

According to a comprehensive literature review of available studies, patients reported improvement in quality of life, and the improvements were considered as a therapeutic outcome by the patients. However, the healthcare providers raised concerns, and were in a dilemma about supporting the therapeutic cannabis use, as the used cannabis was illegally obtained.

A Norwegian study concluded that cannabinoids possess therapeutic effects in neuropathic pain, as well as moderate anti-emetic and appetizing effects in certain groups of patients. Due to non-availability of randomized clinical trials, the study authors were unable to recommend the medical use of cannabis. All of these symptoms and indications are applicable for palliative care cancer patients. To treat vomiting, anorexia and pain, a regimen of at least three drugs should be administered, and the patient must go through the side effects of these medicines. Instead of three drugs, cannabinoids as a monotherapy can be considered to treat all three symptoms, which are common in terminally ill cancer patients. Hence there are grounds to employ medical cannabis as a palliative care drug.

Analgesia is a common benefit shared by opioids and cannabinoids. However, cannabinoids differ from opioids in anti-nociception by the involvement of endocannabinoid system. Further studies suggested the additive effects of cannabinoids and opioids in pain modulation. Medications being prescribed to augment the opioid effects and to reduce the opioid doses are called opioid-sparing drugs. Cannabinoids can greatly increase the analgesic potency of opioids and thus relieve pain in lower doses of opioids. According to studies, cannabis greatly reduced the need for opioids, or even complete eliminated the need for opioid use. Additionally, the cannabinoids work synergistically in alleviating some of the symptoms of terminally ill patients, such as pain in end-stage cancer patients.

Clinical trial evidence found that oral cannabinoids (Sativex) provided better pain relief in opioid-refractory cancer pain than long-acting opioids. The treatment was well-tolerated by the palliative care patients. According to three randomized control studies, cannabis use significantly improved the appetite, weight gain and stabilized body weight in AIDS wasting syndrome. These benefits might be helpful for terminally ill patients suffering from cancer-associated cachexia.

Conclusion

Most of the systematic review studies that are inconclusive or even against the use of medical cannabis have assessed the randomized clinical trials of synthetic cannabinoids such as Dronabinol but not plant-derived cannabinoids. Even some of the studies that assessed the natural cannabinoids lacked adequate statistical power due to flawed clinical trial design. Assessing these studies cannot provide a definitive conclusion.

Conventionally, palliative care management for most of diseases – including cancer – is opioids. Due to inevitable risk of tolerance, the patient has to take more and more narcotics, even if the drug provides little relief. Higher doses can make the patients become more confused and lethargic, with the risk of developing depression, anorexia, nausea and vomiting.

Cannabis could definitely reduce the dosage of these narcotics and also improve the symptoms by its synergistic actions. For terminally ill patients, marijuana could reduce the anguish, improve the quality of life and may also add days to their life.

Complete Article HERE!

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VSED is gaining traction as an end-of-life option

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by Xavier Symons

In the past two decades there has been a dramatic increase in political lobbying to legalise euthanasia and/or physician assisted suicide (E-PAS). Yet even when E-PAS is legalised, many people who have been campaigning for the right to end their lives often remain unable to do so as they do not meet the strict eligibility criteria outlined in law (such as having a terminal illness, and having less than 6 to 12 months to live).

In light of this, and other factors, the notion of Voluntarily Stopping Eating and Drinking (VSED) has gained increased attention in policy discussions. VSED — whereby patients refuse food and hydration and indicate that when incompetent they do not wish to receive it — has been described by bioethicists as a mode of ending one’s life that is legal, in line with medical ethics and a moral prerogative of any patient.

Now it seems that VSED is gaining traction in a clinical context. A new article published in the Journal of Palliative Medicine outlines how long term care facilities such as nursing homes and skilled nurse facilities can facilitate VSED while still respecting “resident safety” and “moral objections to hastened death”. University of Washington palliative care doctor David A. Gruenewald describes how facilities that he has been involved in have managed patient requests for VSED. He argues that VSED may be, where the patient’s wish to end their life is persistent, in accord with “resident-centred care”. Gruenewald calls on long term care facilities to develop evidence based guidelines and guidelines for best practice for dealing with requests for VSED.

In another article in the latest edition of the Canadian Journal of Bioethics, lawyer Jocelyn Downie explores the legal status of VSED in Nova Scotia, Canada, arguing that it is a legal alternative for patients who are ineligible for MAiD (such as early stage Alzheimer’s patients, stroke victims, patients with mental illness and patients with debilitating pain but not terminal illness) who nevertheless wish to end their lives.

Last month BioEdge reported on the case of a 65 year old transgender person from Denver, Colorado, who ended his life by VSED after being diagnosed with early onset Alzheimer’s disease.

Complete Article HERE!

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Grief before death

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– understanding anticipatory grief

Carers often feel grief even though the person they’re caring for is still alive. This could happen if the person being cared for has a life-limiting condition (a condition that has no reasonable hope of a cure), or their personality has been affected by their illness.

Although not everyone experiences this ‘anticipatory grief’, people who do can feel the same emotions and sense of mourning as if the person had actually died.

You may have a wide range of emotions, such as loss, dread, guilt and anxiety. Everyone reacts differently, and it’s good to accept that your coping method is unique.

The grief you might experience may not initially be for the person you care for, but for the life you currently lead. Becoming a carer can change your life dramatically, and you may feel like you’ve lost some of your freedom or social life.

The extra responsibility, and not being able to do anything without planning, can be stressful. You might feel guilty about feeling this way, but it’s a natural reaction to such a big change in your life.

Grieving before a person dies doesn’t necessarily mean that you won’t grieve when they pass away. Everyone reacts differently to these circumstances. While some people feel prepared for the death and have closure, others may start the grieving process all over again.

If you experience pre-death grief, it’s vital for you to talk to someone.

Dealing with conditions that affect a person’s personality and memory can be very traumatic, particularly if you’re caring for a relative or close friend.

Many carers find that they grieve for the loss of the person they once were. You might grieve for the memories that you have together, which the cared-for person will forget. You may grieve for the changes to their personality or for any future plans that they may no longer be able to carry out. You may feel conflicting emotions as the person you look after loses their mental functions or stops recognising you.

Terminal conditions

Finding out that someone you care for has a terminal disease can leave you feeling powerless and devastated.

If you experience pre-death grief, it’s just as vital for you to talk to someone and feel supported as it is when someone has already died. You might find that it helps to talk to friends and family, or the person you care for. A long illness means both of you have time to slowly prepare for the death, to say what you want to say or to share memories. One idea is to write about what the person has meant to you and then read it aloud to them.

You might also consider talking to a counsellor. It can help to discuss your feelings with someone who is objective and doesn’t have emotional ties to the situation. This can help, particularly if the person you care for is in denial about their condition. The counsellor can talk to you about your feelings, suggest ways that you can help the person being cared for, and discuss the difficult post-death decisions that you may need to make, such as organ donation.

Bottling up your emotions can leave you feeling overwhelmed and, in some cases, affect your health. So it’s important to find someone to support you.

Complete Article HERE!

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My Wife Said You May Want to Marry Me

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She encouraged her husband to find new love after she was gone. A year later, he reflects on what her generosity has meant to him.

By Jason B. Rosenthal

I am that guy.

A little over a year ago, my wife, Amy Krouse Rosenthal, published a Modern Love essay called “You May Want to Marry My Husband.” At 51, Amy was dying from ovarian cancer. She wrote her essay in the form of a personal ad. It was more like a love letter to me.

Those words would be the final ones Amy published. She died 10 days later.

Amy couldn’t have known that her essay would afford me an opportunity to fill this same column with words of my own for Father’s Day, telling you what has happened since. I don’t pretend to have Amy’s extraordinary gift with words and wordplay, but here goes.

During our life together, Amy was a prolific writer, publishing children’s books, memoirs and articles. Knowing she had only a short time to live, she wanted to finish one last project. We were engaged then in home hospice, a seemingly beautiful way to deal with the end of life, where you care for your loved one in familiar surroundings, away from the hospital with its beeping machines and frequent disruptions.

I was posted up at the dining room table overlooking our living room, where Amy had established her workstation. From her spot on the couch, she worked away between micro-naps.

These brief moments of peace were induced by the morphine needed to control her symptoms. A tumor had created a complete bowel obstruction, making it impossible for her to eat solid food. She would flutter away on the keyboard, doze for a bit, then awake and repeat.

When Amy finished her essay, she gave it to me to read, as she had done with all of her writing. But this time was different. In her memoirs she had written about the children and me, but not like this. How was she able to combine such feelings of unbearable sadness, ironic humor and total honesty?

When the essay was published, Amy was too sick to appreciate it. As the international reaction became overwhelming, I was torn up thinking how she was missing the profound impact her words were having. The reach of Amy’s article — and of her greater body of work — was so much deeper and richer than I knew.

Letters poured in from around the world. They included notes of admiration, medical advice, commiseration and offers from women to meet me. I was too consumed with grief during Amy’s final days to engage with the responses. It was strange having any attention directed at me right then, but the outpouring did make me appreciate the significance of her work.

When people ask me to describe myself, I always start with “dad,” yet I spent a great deal of my adult life being known as “Amy’s husband.” People knew of Amy and her writing, while I had lived in relative anonymity. I had no social media presence and my profession, a lawyer, did not cast me into public view.

After Amy died, I faced countless decisions in my new role as a single father. As in any marriage or union of two people with children, we had a natural division of labor. Not anymore. People often assumed Amy was disorganized because she had list upon list: scattered Post-it notes, scraps of paper and even messages scrawled on her hand. But she was one of the most organized people I have ever met.

There are aspects of everyday life I have taken on that I never gave much consideration to in the past. How did Amy hold everything together so seamlessly? I am capable of doing many things on my own, but two people can accomplish so much more together and also support each other through life’s ups and downs.

Many women took Amy up on her offer, sending me a range of messages — overly forward, funny, wise, moving, sincere. In a six-page handwritten letter, one woman marketed her automotive knowledge, apparently in an effort to woo me: “I do know how to check the radiator in the vehicle to see if it may need a tad of water before the engine blows up.”

While I do not know much about reality TV, there was also this touching letter submitted by the child of a single mother, who wrote: “I’d like to submit an application for my mom, like friends and family can do for participants on ‘The Bachelor.’”

And I appreciated the sentiment and style of the woman who wrote this: “I have this image of queues of hopeful women at the Green Mill Jazz Club on Thursday nights. Single mothers, elegant divorcées, spinster aunts, bored housewives, daughters, wilting violets … all in anxious anticipation as to whether the shoe will fit, fit them alone, that the prince from the fairy tale is meant for them. That they are the right person.”

I couldn’t digest any of these messages at the time, but I have since found solace and even laughter in many of them. One thing I have come to understand, though, is what a gift Amy gave me by emphasizing that I had a long life to fill with joy, happiness and love. Her edict to fill my own empty space with a new story has given me permission to make the most out of my remaining time on this planet.

If I can convey a message I have learned from this bestowal, it would be this: Talk with your mate, your children and other loved ones about what you want for them when you are gone. By doing this, you give them liberty to live a full life and eventually find meaning again. There will be so much pain, and they will think of you daily. But they will carry on and make a new future, knowing you gave them permission and even encouragement to do so.

I want more time with Amy. I want more time picnicking and listening to music at Millennium Park. I want more Shabbat dinners with the five of us Rosies (as we Rosenthals are referred to by our family).

I would even gladly put up with Amy taking as much time as she wants to say goodbye to everyone at our family gatherings, as she always used to do, even after we had been there for hours, had a long drive home ahead of us and likely would see them again in a few days.

I wish I had more of all of those things, just as Amy had wished for more. But more wasn’t going to happen for her or us. Instead, as she described, we followed Plan “Be,” which was about being present in our lives because time was running short. So we did our best to live in the moment until we had no more moments left.

The cruelest irony of my life is that it took me losing my best friend, my wife of 26 years and the mother of my three children, to truly appreciate each and every day. I know that sounds like a cliché, and it is, but it’s true.

Amy continues to open doors for me, to affect my choices, to send me off into the world to make the most of it. Recently I gave a TED Talk on the end of life and my grieving process that I hope will help others — not something I ever pictured myself doing, but I’m grateful for the chance to connect with people in a similar position. And of course I am writing to you now only because of her.

I am now aware, in a way I wish I never had to learn, that loss is loss is loss, whether it’s a divorce, losing a job, having a beloved pet die or enduring the death of a family member. In that respect, I am no different. But my wife gave me a gift at the end of her column when she left me that empty space, one I would like to offer you. A blank space to fill. The freedom and permission to write your own story.

Here is your empty space. What will you do with your own fresh start?

Humbly, Jason

Complete Article HERE!

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Pagans, Death and the Afterlife

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For many modern Pagans, there is a somewhat different philosophy on death and dying than what is seen in the non-Pagan community. While our non-Pagans see death as an ending, some Pagans view it as a beginning of the next phase of our existence. Perhaps it is because we view the cycle of birth and life and death and rebirth as something magical and spiritual, a never-ending, ever turning wheel. Rather than being disconnected from death and dying, we tend to acknowledge it as part of a sacred evolution.

In The Pagan Book of Living and Dying, author Starhawk says, “Imagine if we truly understood that decay is the matrix of fertility… we might view our own aging with less fear and distaste, and greet death with sadness, certainly, but without terror.”

As the Pagan population ages – and certainly, we are doing so – it’s becoming more and more likely that at some point each of us will have to bid farewell to a fellow Pagan, Heathen, Druid, or other member of our community. When that happens, what is the appropriate response? What can be done to honor the person’s beliefs and send them on their way in a way that they themselves would have valued, while still managing to maintain sensitivity in dealing with their non-Pagan family members and friends?

Views of the Afterlife

Is death the end, or just another beginning?

Many Pagans believe that there is some sort of afterlife, although that tends to take varying forms, depending on the individual belief system. Some followers of NeoWiccan paths accept the afterlife as the Summerland, which Wiccan author Scott Cunningham described as a place where the soul goes on to live forever. In Wicca: A Guide for the Solitary Practitioner, he says, “This realm is neither in heaven nor the underworld. It simply is — a non-physical reality much less dense than ours. Some Wiccan traditions describe it as a land of eternal summer, with grassy fields and sweet flowing rivers, perhaps the Earth before the advent of humans. Others see it vaguely as a realm without forms, where energy swirls coexist with the greatest energies – the Goddess and God in their celestial identities.”

Members of non-Wiccan groups, particularly those who follow a more Reconstructionist slant, may see the afterlife as Valhalla or Fólkvangr, for those who adhere to a Norse belief system, or Tir na nOg, for individuals who participate in a Celtic path. Hellenic Pagans may see the afterlife as Hades.

For those Pagans who don’t have a defined name or description of the afterlife, there is still typically a notion that the spirit and the soul live on somewhere, even if we don’t know where it is or what to call it.

Tawsha is a Pagan in Indiana who follows an eclectic path. She says, “I don’t know what happens to us when we die, but I like the idea of the Summerland. It seems peaceful, a place where our souls can regenerate before they reincarnate into a new body. But my husband is a Druid, and his beliefs are different and focus more on the Celtic view of the afterlife, which seems a little more ethereal to me. I think it’s really all just different interpretations of the same place.”

Deities of Death and the Afterlife

Anubis guided the souls of the dead through the underworld.

Cultures have, since the beginning of time, honored deities associated with the process of dying, the act itself, and the journey of the spirit or soul into the afterlife. Although many of them are celebrated during the harvest season, around Samhain, when the earth itself is slowly dying, it is not uncommon to see them called upon as someone is approaching their last days, or has recently crossed over.

If you follow an Egyptian, or Kemetic, path, you may choose to honor Anubis, the jackal headed god of death. Anubis’ job is to determine whether the deceased is worthy of entering the underworld, by taking the individual’s measure. To help ease their passing, you may choose to sing or chant to Anubis about the dying or dead person’s accomplishments.

For Pagans who follow an Asatru or Heathen belief system, prayers and chants to Odin or to the goddesses Hel and Freya might be appropriate. Half of the warriors who die in battle go to spend the afterlife with Freya in her hall, Folkvangr, and the others go to Valhalla with Odin. Hel takes charge of those who have died from old age or sickness, and accompanies them to her hall, Éljúðnir.

A Maryland Heathen who asked to be identified as Wolfen says when his brother died, “We had this huge ceremony with a big bonfire, lots of drinking and toasts, and song. My brother had already been cremated, but we added his ashes to the fire, and we sang a song honoring him and his accomplishments, and introducing him to Odin and Valhalla, and then we continued it by calling upon our ancestors, going back about eight generations. It was what he wanted, and probably the closest thing to a Viking funeral that you can get in suburban America.”

Other deities you may wish to call upon as someone is dying, or has crossed over, include the Greek Demeter, Hecate, and Hades, or the Chinese Meng Po. Be sure to read more about: Deities of Death and the Afterlife.

Funerary Rites

In many countries in the modern world, the practice of burying the dead is common. However, it’s a relatively new concept by some standards, and in some places, it’s almost a novelty. In fact, many of today’s contemporary funeral practices might be considered a bit strange by our ancestors.

In other societies, it is not uncommon to see the dead interred in trees, placed on giant funeral pyres, closed up in a ceremonial tomb, or even left out for the elements to consume.

One trend that is increasing in popularity in the Western world is that of “green burial,” in which the body is not embalmed, and is simply buried in the soil with no coffin, or with a biodegradable container. While not all areas permit this, it is something worth looking into for someone who truly wishes to be returned to earth as part of the cycle of life and death.

Memorial and Ritual

How will you be remembered when you’ve crossed over?

Many people – Pagans and otherwise – believe that one of the best ways to keep someone’s memory alive is to do something in their honor, something that keeps them alive in your heart long after theirs has stopped beating. There are a number of things you can do to honor the dead.

Rituals: Hold a memorial ritual in the individual’s honor. This can be as simple as lighting a candle in his or her name, or as complex as inviting the entire community together to hold a vigil and offer blessings for the person’s spirit as they cross over into the afterlife.

Causes: Did the deceased person have a favorite cause or charity that they worked hard to support? A great way to memorialize them is to do something for that cause that meant so much to them. Your friend who adopted all of those shelter kittens would probably love it if you made a donation to the shelter in her name. How about the gentleman who gave so much time to cleaning up local parks? What about planting a tree in his honor?

Jewelry: A popular trend during the Victorian era was to wear jewelry in the deceased’s honor. This might include a brooch holding their ashes, or a bracelet woven from their hair. While this may sound a bit morbid to some folks, bereavement jewelry is making quite a comeback. There are a number of jewelers who offer memorial jewelry, which is typically a small pendant with a hole in the back. Ashes are poured into the pendant, the hole is sealed with a screw, and then the friends and family of the dead can keep them nearby any time they like.

Be sure to read the following articles on death, dying and the afterlife:

  • Caring for Our Dead: Every society, throughout history, has found some way to attend to the proper care of their dead. Let’s look at some of the different methods in which various cultures have said farewell to their loved ones.
  • Ray Buckland on Death and Dying: Wiccan author Ray Buckland recently did a presentation on a Pagan view of death and dying. He has graciously allowed us permission to share that presentation here on the Pagan/Wiccan website.
  • What Happens to Your Magical Items After You Die? Since so many members of the Pagan community work as solitaries, and may never come into contact with other Pagans during their lifetime, one issue that comes up as our population ages is that of what to do with magical tools and other items after death.
  • A Pagan Blessing for the Dead: This simple memorial ceremony can be performed for a deceased loved one. It invokes the powers of the earth, air, fire and water to send the departed off to their next destination.
  • Prayer for the Dying: This prayer is one which may be said by or on behalf of a dying person, and addresses the need we have to feel at home in the last moments of life.
  • Prayer to Hel: In Norse mythology, Hel features as a goddess of the underworld. She was sent by Odin to Helheim/Niflheim to preside over the spirits of the dead, except for those who were killed in battle and went to Valhalla. It was her job to determine the fate of the souls who entered her realm.
  • Prayer to Anubis: This prayer honors the Egyptian god of the underworld, Anubis. He is honored as the god who takes our measure when we cross from this life into the next.
  • Prayer to the Gods of Death: At Samhain, the earth is growing cold and dark. It is a time of death, of endings and beginnings. This prayer honors some of the deities associated with death and the underworld.

Complete Article HERE!

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5 Steps for Dealing with Anticipatory Grief

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It might be the hardest part of caregiving: Watching your loved one slip away step by terrible step, knowing you can’t stop the decline and grieving the loss of the person you once knew, long before they’re actually gone. Psychologists call this process anticipatory grief, and it’s very common among caregivers and family members of those suffering from Alzheimer’s disease, cancer, and other terminal illnesses.

Coping with Your Grief

“As a disease progresses, there is so much frustration and sadness associated with watching the person you once knew go away,” says Vince Corso, M.Div, LCSW, CT. “It can be overwhelming.”

Corso provided care to his mother, who suffered from Alzheimer’s. He found one of the painful milestones of the disease as the point at which she no longer recognized him. “My mom didn’t recognize us, and she confused us with other people. As a son and a caregiver, that was really hard. I had to leave the room.” But after a period of time, he says, he became acclimated to his new reality and began to accept it. He found that sharing the sense of loss with family members can be very helpful. “It’s so crucial that family members talk about the loss.”

Here are some other ways caregivers can work through their feelings of anticipatory grief:

Allow feelings of grief to help you prepare

Take time to examine unresolved issues between you and your loved one. Imagine life without him or her. “Say what needs to be said,” Corso advises. And if your family member is still well enough, settle legal and financial matters and discuss end-of-life wishes.
Educate yourself about what to expect

Learn about your family member’s condition—know the symptoms, the side effects from any treatments, and the prognosis. It may help you to feel in control if you understand what is coming down the pike.

Talk to somebody

Find a support group of people who are experiencing the same thing, whether it is online, in person, or over the phone. “Someone in a similar situation can provide a lot of insight,” says Corso. “And it’s okay to be honest about your feelings. You’re not being disrespectful to your family member if you express your frustration.”

Enlist help and continue to live your life

Reach out to family and friends or hire someone to help with the care of your loved one. Don’t put your life on hold. Meet with friends and try to have fun when you can. “In the long run, it will help the patient and yourself,” says Corso. “You’ll have more energy to care for your loved one and to do what you need to do.”

Create moments your family member can enjoy

Even though your family member is no longer the person she once was, she can still enjoy pleasurable activities with you. Take mom outside for some fresh air, play music for her, do simple puzzles if she is able. In the end, these moments might be what you cherish most.

Helping Your Loved One Adjust

When illness or injury robs your loved one of the ability to remember things about themselves, it can be scary and profoundly difficult. How do you help them cope with the changes in memory and identity?

Look for ways to add new activities to your loved one’s life, or think about how you might incorporate elements of a favorite pastime. If your mother was an avid golfer, she may have no interest in taking up knitting if her doctor tells her to stay off the links. Ask her what she misses about golf, though, and you may realize that she misses the camaraderie more than the activity itself. Would she be able to meet her foursome for lunch after they’ve finished their round?

Remember too that this is a type of loss. Feelings associated with the grieving process, including denial, anger, and depression, are normal. Talking to a social worker, therapist, clergyperson, or even a sympathetic friend may help you or your loved one manage the emotions and come to terms with the loss. If there’s a support group in your area, hearing how others have coped with the changes you’re experiencing can provide insight and concrete steps, and learning that you aren’t alone in your feelings can be reassuring.

Complete Article HERE!

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Do We Have A Right To A ‘Good Death’?

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Should doctors do everything they can to preserve life, or should some medical techniques, such as cardio-pulmonary resuscitation (CPR), be a matter of patient choice? Doctor Sarah Simons wades into the debate and argues that ‘do not resuscitate’ decisions are all about patients’ human rights.

Of all our human rights, the right to life is the one most often held up as the flagship, fundamental right: after all, without life, how can one learn, love, communicate, play or have a family?

The right to life is closely linked to the right to health. Under the International Covenant on Economic, Social and Cultural Rights, which the UK has signed and ratified, states are required to “recognise the right of everyone to the enjoyment of the highest attainable standard of physical and mental health”.

Protecting patients’ rights to life and health involves providing necessary life-saving treatment (known as resuscitation) if their life is threatened by serious illness or injury. It also involves enabling patients to live as well as possible for as long as possible: for example, by treating preventable diseases and encouraging people to adopt a healthy lifestyle. However, although many aspects of medicine and health are unpredictable, death is the one certainty for all of us.

Is There a Right to a Good Death?

In recent years, there has been much debate surrounding how healthcare practitioners should approach end-of-life issues with patients. A ‘good, natural death’ is increasingly recognised as a part of someone’s human right to life.

When healthcare professionals acknowledge that someone is approaching the final stages of their life, and no longer responding to life-saving treatment, treatment is not withdrawn, but instead, the goal is changed to treatment focussed on preserving the patient’s quality of life and managing their symptoms in accordance with their wishes. It’s important to draw a distinction between this and the ethical debate on euthanasia, which is altogether different from end-of-life care and natural death.

A ‘good, natural death’ is increasingly recognised as a part of someone’s human right to life.

Sarah Simons

This change of focus often includes completing a ‘Do Not Resuscitate’ (DNR) order, instructing healthcare teams not to carry out cardiopulmonary resuscitation (CPR) when the patients’ heart and lungs cease to work. This decision is usually made on the grounds of pre-existing medical conditions and poor physiological reserve and frailty, which mean that CPR will not be successful. A DNR should always take into account the patient’s informed opinion on the matter, or at least their next of kin’s.

A DNR decision only refers to CPR. The patient can still receive treatment for related issues, such as antibiotics for an infection, and all other life-preserving or life-saving treatments can be given until the patient’s heart and lungs stop working. A DNR decision never means that life-saving treatment is not given – the purpose of a DNR is to allow the patient to pass away naturally and peacefully, with dignity and without traumatic medical intervention.

What Exactly is CPR?

Understanding the reality of CPR is vital to understanding why it is a human rights issue. CPR is used when someone has a cardiac arrest, which means they have suddenly stopped breathing and their heart has stopped beating.

CPR specifically refers to the chest compressions, electric shocks and artificial breathing technique used to stimulate and replicate the beating of the heart to pump blood around the body and the breaths taken to inflate the lungs with oxygen. This is effective when a sudden cardiac arrest occurs and someone’s organs stop unexpectedly, but the underlying mechanism of a cardiac arrest is very different from when the heart stops beating as part of the body’s natural decline at the end of life

CPR is traumatic, undignified and usually unsuccessful in patients of all ages.

Sarah Simons

Sadly, despite Hollywood’s optimistic depictions of resuscitation, the reality is that CPR is often traumatic, undignified and usually unsuccessful in patients of all ages. CPR will not reverse years of gradually shrinking muscle mass, rejuvenate brains worn down by the steady decline of dementia, remove cancerous tumours or clear obstructed lungs weathered by years of COPD, which are often the underlying causes when someone’s heart and lungs have stopped.

 

CPR will cause bruising, vomiting, bleeding and broken ribs. CPR will render someone’s dying moments traumatic and undignified, and it will leave their friends and families with lasting memories of a failed, brutal resuscitation rather than a mental image of their loved one peacefully slipping away pain-free and asleep.

What Do Experts Have to Say About This?

Guidance published by the General Medical Council (GMC) in 2016 emphasised the importance of recognising patients’ human rights in relation to decisions about CPR and end-of-life care. The guidance recognised that “provisions particularly relevant to decisions about attempting CPR include the right to life (Article 2) [and] the right to be free from inhuman or degrading treatment (Article 3)”.

Article 3 of the Human Rights Convention specifically refers to the right to protection from inhuman or degrading treatment, and understanding the brutal, traumatic reality of CPR is a crucial consideration when thinking about DNR decisions. The GMC goes on to reference “the right to respect for privacy and family life (Article 8), the right to freedom of expression, which includes the right to hold opinions and to receive information (Article 10) and the right to be free from discrimination in respect of these rights (Article 14).”

The GMC guidance also highlights that the Human Rights Act, (which incorporates the Human Rights Convention into UK law), “aims to promote human dignity and transparent decision-making”, which should also be key concerns for doctors making decisions across all aspects of medicine.

Making the Right Choice For The Patient

Having open, frank discussions about CPR, and end-of-life decisions in general, enables healthcare professionals and patients to make informed decisions together. Doing so empowers patients to ask questions and insist that their rights are respected. It gives patients time to talk to their loved ones about what’s important to them, including any religious considerations, before their health deteriorates to a point where these conversations may not be possible. 

Having open, frank discussions about CPR … enables healthcare professionals and patients to make informed decisions together.

Sarah Simons

Avoiding these conversations, while perhaps understandable given that no-one likes to think of their loved ones dying, means that important questions may not get asked and the patient’s wishes may go unheard. Making decisions on CPR and other practical matters is important, but so is acknowledging that someone wants to spend their last days eating mint chocolate chip ice cream at home listening to a specific Eva Cassidy album whilst surrounded by their pets and children.

As the NHS turns 70 later this year, and continues to navigate the challenges of an ageing population, conversations about end-of-life care are more important than ever before. Grief and bereavement are difficult, emotionally charged topics of conversation, but death is a normal human process. Taking the opportunity to talk about what we want at the end of our lives empowers us to make informed decisions and ultimately help all of us to die well one day.

Complete Article HERE!

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