For terminally ill cancer patients, where you live can shape end-of-life care


If you are a terminally ill cancer patient, where you live can determine how much it will cost for you to die.

The last month of life for a Medicare patient diagnosed with advanced-stage lung or colorectal cancer cost an average of $13,663, according to a study published today in the journal Health Affairs. But that cost can also vary widely, the study suggested, from $10,131 per patient in the lowest 20 percent of hospital referral regions included in this study to $19,318 in the highest 20 percent.

What drives those price differences? A physician’s medical philosophy and practice styles propelled higher medical bills, and patients in geographic areas with fewer primary doctors and hospices per capita also tended to have higher end-of-life costs, the study said.

Researchers reached this conclusion after surveying physicians on what they believed, how those beliefs played out in practice and how skilled they were in delivering end-of-life care, along with patient and claims data.

These findings underscored how important end-of-life decisions are, even when a patient may be days away from death,said Nancy Keating, a health care policy professor at Harvard Medical School and physician who led a team of researchers for this study. For instance: Does it make sense to give a stage-IV lung cancer patient with virtually no prospects of recovery a fourth round of chemotherapy? Or would it be better to talk about entering hospice care?

“We need to do a better job of helping train physicians to feel more comfortable and be more comfortable talking about end-of-life care with patients,” Keating said.

Nearly 40 percent of the 3,139 doctors in the study said they strongly agreed that they were “well prepared” to offer end-of-life care. Roughly as many — 43 percent — said they would recommend chemotherapy to a patient with late-stage lung cancer, despite concerns about that patient’s ability to recover or the pain they might endure. Yet two-thirds of physicians said they would prefer hospice if they were terminally ill.

For patients, 12 percent of those surveyed said they believed “cancer can be cured” and as many patients said cancer treatment can result in “serious side effects,” according to Keating’s data analysis. More than a third of patients said they wanted treatment that could help them live longer “even if it causes more pain” and 43 percent of patients said they preferred such treatment even if it drained their finances.

This study joins a growing body of research on lowering health spending and the role of palliative and end-of-life care in improving the final days of a patient’s life, said Otis Brawley, who serves as chief medical officer for the American Cancer Society and did not contribute to this study.

“The growth of palliative and hospice care in the U.S. is really important for improving quality of care,” Brawley said.

For years, Keating has pored through Medicare and Medicaid oncology data to figure out how to better spend money. In this latest effort, she analyzed claims data for 1,132 Medicare patients age 65 or older who had been diagnosed with late-stage lung or colorectal cancer between 2003 and 2005. Her team then tracked those patients until 2012 using the Cancer Care Outcomes Research and Surveillance Consortium study that draws on registries of cancer patients.

She linked patient information from these two datasets to overcome what she sees as a weakness in many studies about health care costs — researchers often only see a snapshot of a living patient. This study tracked them throughout multiple points in time. That said, Keating concedes that a limitation of this study is that many patients died by the late 2000s , narrowing the pool of people who could be studied beyond that point. Most patients — 65 percent — died by 2005, within the first three years of the study period.

In this study, researchers scanned 26 hospital referral regions — from McAllen, Texas, to Manhattan, New York — of the 306 regions nationwide. Patients were assigned to these regions based on the ZIP code where they lived at the time they were diagnosed with cancer.

“In a perfect world, we would have gotten national data,” Keating said, but capturing responses from newly diagnosed cancer patients about their care preferences “would have been impossible.”

There are some “very human reasons” that may account for disparities in price and treatment preferences, Brawley said in an email to the PBS NewsHour. Sometimes, primary care physicians develop long-standing relationships with the families they serve, he said, and specialty physicians also forge bonds with families when a patient endures the trauma of receiving treatment for a life-threatening illness. This might make a physician more apt to suggestion additional interventions, despite negative side effects.

“Some would criticize them for believing too much in the medicine they practice,” Brawley said, “but my experience is it’s more complicated than that.”

The calculus of treating patients with advanced-stage cancer is difficult, said Laurence Heifetz, medical director at Gene Upshaw Memorial Tahoe Forest Cancer Center in Truckee, California, a rural cancer care practice he has built north of Lake Tahoe over the last 12 years.

A patient’s expectations don’t always align with what the best treatment might be or with what resources are currently available, said Heifetz, who also spent two decades treating cancer patients at 1,000-bed Cedars-Sinai Medical Center in Los Angeles.

When considering palliative care, it’s hard for doctors to know who has six months left to live — the threshold for offering end-of-life services, Heifetz said. And a treatment that works for one patient may not for the next, even if they have the same type of cancer, he said: “We don’t know who will respond, and then we’re blamed after the fact for giving an unnecessary drug to someone who dies.”

But Heifetz thinks he knows one way to bring down cost while delivering high-quality care: “An earlier, more honest conversation with patients will allow for more realistic acceptance of the sentence, ‘I guess it’s time to quit.’”

Complete Article HERE!

I Know You Love Me — Now Let Me Die

A physician laments the often-excessive care of older adults at the end of life

By Louis M. Profeta, M.D.

In the old days, she would be propped up on a comfy pillow, in fresh cleaned sheets under the corner window where she would, in days gone past, watch her children play. Soup would boil on the stove just in case she felt like a sip or two. Perhaps the radio softly played Al Jolson or Glenn Miller, flowers sat on the nightstand, and family quietly came and went.

These were her last days. Spent with familiar sounds, in a familiar room, with familiar smells that gave her a final chance to summon memories that will help carry her away.

She might have offered a hint of a smile or a soft squeeze of the hand but it was all right if she didn’t. She lost her own words to tell us that it’s OK to just let her die, but she trusted us to be her voice and we took that trust to heart.

A day does not go by where my partners don’t look at each other and say, “How do we stop this madness?”

You see, that’s how she used to die. We saw our elderly different then.

Still the Same Person

We could still look at her face and deep into her eyes and see the shadows of a soft, clean, vibrantly innocent child playing on a porch somewhere in the Midwest during the 1920s perhaps. A small rag doll dances and flays as she clutches it in her hand. She laughs with her barefoot brother, who is clad in overalls, as he chases her around the yard with a grasshopper on his finger. She screams and giggles. Her father watches from the porch in a wooden rocker, laughing while mom gently scolds her brother.

We could see her taking a ride for the first time in an automobile, a small pickup with wooden panels driven by a young man with wavy curls. He smiles gently at her while she sits staring at the road ahead; a fleeting wisp of a smile gives her away. Her hands are folded in her lap, clutching a small beaded purse.

‘Enriched and Happy’

We could see her standing in a small church. She is dressed in white cotton, holding hands with the young man, and saying, “I do.” Her mom watches with tearful eyes. Her dad has since passed. Her new husband lifts her across the threshold, holding her tight. He promises to love and care for her forever. Her life is enriched and happy.

We could see her cradling her infant, cooking breakfast, hanging sheets, loving her family, sending her husband off to war, and her child to school.

We could see her welcoming her husband back from battle with a hug that lasts the rest of his life. She buries him on a Saturday under an elm, next to her father. She marries off her child and spends her later years volunteering at church functions before her mind starts to fade and the years take their toll and God says: “It’s time to come home.”

Adding Time but Not Life

This is how we used to see her before we became blinded by the endless tones of monitors and whirrs of machines, buzzers, buttons and tubes that can add five years to a shell of a body that was entrusted to us and should have been allowed to pass quietly propped up in a corner room, under a window, scents of homemade soup in case she wanted a sip.

You see now we can breathe for her, eat for her and even pee for her. Once you have those three things covered she can, instead of being gently cradled under that corner window, be placed in a nursing home and penned in a cage of bed rails and soft restraints meant to “keep her safe.”

She can be fed a steady diet of Ensure through a tube directly into her stomach and she can be kept alive until her limbs contract and her skin thins so much that a simple bump into that bed rail can literally open her up until her exposed tendons are staring into the eyes of an eager medical student looking for a chance to sew.

She can be kept alive until her bladder is chronically infected, until antibiotic resistant diarrhea flows and pools in her diaper so much that it erodes her buttocks. The fat padding around her tailbone and hips are consumed and ulcers open up, exposing the underlying bone, which now becomes ripe for infection.

‘We Stopped Seeing Her’

We now are in a time of medicine where we will take that small child running through the yard, being chased by her brother with a grasshopper on his finger, and imprison her in a shell that does not come close to radiating the life of what she once had.

We stopped seeing her, not intentionally perhaps, but we stopped.

This is not meant as a condemnation of the family of these patients or to question their love or motives, but it is meant be an indictment of a system that now herds these families down dead-end roads and prods them into believing that this is the new norm and that somehow the old ways were the wrong ways and this is how we show our love.

A day does not go by where my partners don’t look at each other and say, “How do we stop this madness? How do we get people to let their loved ones die?”

I’ve been practicing emergency medicine for close to a quarter of a century now and I’ve cared for countless thousands of elderly patients. I, like many of my colleagues, have come to realize that while we are developing more and more ways to extend life, we have also provided water and nutrients to a forest of unrealistic expectations that have real-time consequences for those frail bodies that have been entrusted to us.

A Slow, But Enormous Change

This transition to doing more and more did not just happen on a specific day in some month of some year. Our end-of-life psyche has slowly devolved and shifted and a few generations have passed since the onset of the Industrial Revolution of medicine.

Now we are trapped. We have accumulated so many options, drugs, stents, tubes, FDA-approved snake oils and procedures that there is no way we can throw a blanket over all our elderly and come to a consensus as to what constitutes inappropriate and excessive care. We cannot separate out those things meant to simply prolong life from those meant to prolong quality life.

Nearly 50 percent of the elderly U.S. population now die in nursing homes or hospitals. When they do finally pass, they are often surrounded by teams of us doctors and nurses, medical students, respiratory therapists and countless other health care providers pounding on their chests, breaking their ribs, burrowing large IV lines into burned-out veins and plunging tubes into swollen and bleeding airways.

‘What in the Hell Were You Thinking?’

We never say much as we frantically try to save the life we know we can’t save or perhaps silently hope we don’t save. When it’s finally over and the last heart beat blips across the screen and we survey the clutter of bloody gloves, wrappers, masks and needles that now litter the room, you may catch a glimpse as we bow our heads in shame, fearful perhaps that someday we may have to stand in front of God as he looks down upon us and says, “What in the hell were you thinking?”

When it comes time for us to be called home, those of us in the know will pray that when we gaze down upon our last breath we will be grateful that our own doctors and families chose to do what they should instead of what they could, and with that we will close our eyes to familiar sounds in a familiar room, a fleeting smile and a final soft squeeze of a familiar hand.

Complete Article HERE!

Professional death coaches: A new type of doula

Two B.C. women Explore the sacred journey between life and death

Alison Moore and Sue Berlie


Death is no stranger to two Okanagan women, who have guided their loved ones through the unique journey.

What’s new, however, is their growing role in helping the wider community embrace a different kind of death experience.

“There’s a lot of paradigm shift(ing) happening right now, people want to talk about it,” said Sue Berlie, shamanic coach, death walker and psychopomp.

Berlie, alongside Alison Moore, a life-cycle celebrant and sacred passages doula are also both trained as home funeral guides through the Canadian Integrative Network for Death Education and Alternation (CINDEA). They are also facilitators of the Okanagan Death Cafe.

Celebrant Alison Moore

Death Cafes were created in 2004 and has spread around the world. The events offer unique opportunities for conversations about death, the dying process and preparation to be had. Through guided in-depth conversations with each other, participants find solace and a new understanding of a usually taboo subject. Currently, 6,588 Death Cafes have been hosted in 56 countries.

Berlie and Moore were drawn the worldwide Death Cafes because of their grassroots nature, and the high demand for people wanting to get more involved with the death and caring of their friends and family. They were also getting sick of the current “business” of dying.

“A lot of people want to die at home and aren’t given that opportunity, and when they do (die at home) we don’t let them lie there and have their friends and family come in where we can hold services … rather, the person dies and has been whisked off to a funeral home and everyone has been left there with a void,” Moore said.

Funerals cost somewhere between $1,000 to $12,000 according to Canadian Death Services Online , and B.C. currently has the highest rates for cremation in Canada.

Seventy per cent of North Americans prefer to die at home, and only seven per cent said they wanted to die in a hospice or palliative care home, in a survey conducted by Donna Wilson, at the University of Alberta. Wilson also teaches nursing and researches dying in Canada and the survey also found that 60 per cent of Canadians actually die in hospital and 10 per cent die in nursing homes.

Outside of religion, rituals to be held after death are lacking and that’s become a problem.

“People are having a deeper experience when helping and preparing for death, part of what we are excited about is helping people grieve well. You should die well and grieve well,” Moore said.

Moore’s education in the world of death and dying began when she found out she was expecting her first child and her best friend was diagnosed with stage four breast cancer.


“Here I was gestating life and my best friend was given three to six months to live. She ended up living on Elisabeth Kübler-Ross’ farm (a pioneer in near-death studies and author of On Death and Dying) and becoming one of the subjects in her book. She brought us on this journey of spiritual exploration with her,” Moore said.

Talking about death and dying hasn’t been difficult since that perspective-shifting experience. Now as a celebrant, Moore “marries and buries” people, guiding them through different life-changing experiences; the birth of a child, officiating marriages and officiating funerals.

Moore is now a certified death doula whose first guided her father through death.

“It was very interesting being on the inside, as a daughter, and being the person that was trying to hold space for the person I was caring for — it was an extraordinary experience. We are trained to focus on the person we are caring for, providing them with a beautiful quality of life and death. We are of service to the path that the person is taking, and it is a sacred one.”

Berlie, a psychopomp (a guide of souls to the place of the dead) takes a different spiritual journey in her work. There is no general scenario, as she works on a case by case basis. She can be there during a death, after, or if asked by a family member or the person who is dead to ensure their spirit is not trapped. Berlie also facilitates conversations, ceremonies and rituals. Berlie calls it dreaming themselves into their next life.

“It will always depend on what people believe, you have to stay within their beliefs, you cannot introduce anything. It is about them and what they want,” Berlie said. “Dreaming into what is next, is more of a conversation and I see that with the more Death Cafe’s we hold, the more people become open to other things and they start to explore within themselves wondering “well maybe my body doesn’t just shut down and that’s it for my spirit.””

Sue Berlie

Berlie works alongside spirit guides, spirit animals and the realms to help spirits continue onto the journey of what is next.

Her work began when she was 18 years-old and her best friend died suddenly in a car accident.

“He stood there clear as day and talked to me the night he died— I later went to a psychic 30 years later and she said “Oh who is that over your left shoulder? You have a bright gold orb hovering there, he hasn’t left your side.” It was my friend and he didn’t realize he was dead. He is my spirit guide and I believe he helps me in my work.”

Berlie later volunteered at a hospice and found she was not able to help people in their last stage of life in the way she felt compelled to. She changed her career in order to strengthen her ability as a psychopomp by becoming a shamanic practitioner, and certified death walker. Shamanic practitioners are healers who move into an altered state of consciousness to access a hidden reality in the spirit realms with the purpose of bringing back healing, power and information.

As a death walker Berlie accompanies people as the go onto their journey towards death, nurturing, enhancing and strengthening the capacity of the person about to die. While providing legal and practical knowledge to them and the family.

The next Okanagan Death Cafe series has yet to be scheduled but the women have decided to host them bi-monthly instead of annually to accommodate and continue the conversations around death and dying.

“What I would like to see and what is beginning in these dialogues on death and dying is, that people are opening up to the fact that the one thing we know when we are born is that we are going to die. We need to start embracing in our daily lives, because each day is a gift,” Alison Moore said.

For more information, or to find a Death Cafe near you please visit

Complete Article HERE!

Fewer Americans are spending their final days in the hospital and more are dying at home

A woman receives hospital-level care from a nurse in her home. More Americans are opting to spend their final days at home instead of in a hospital, according to a new study.


The American way of dying seems to have become less frantic, desperate and expensive.

That’s the upshot of a new study that finds that seniors insured by Medicare who died in 2015 were less likely to do so in a hospital and more likely to pass away in a home or other community setting than those who died in 2000.

The new research also showed that the proportion of American seniors who were admitted to the intensive care unit during their final month of life has stabilized after rising between 2000 and 2009. By 2015, 29% of dying patients insured by Medicare spent part of their final month of life in the ICU.

The study also chronicled a slight decline in the proportion of Medicare patients who spent time on a ventilator during their final days and whose last three days of life were affected by a transfer from one institution to another — say, from a nursing home to the hospital.

The findings were published this week in the Journal of the American Medical Assn. They were based on an analysis of records from 1,361,870 Medicare fee-for-service enrollees and 871,845 Medicare Advantage enrollees who died between 2000 and 2015. Their average age at their time of death was 82.

In all, just short of 20% of Medicare-insured patients who died in 2015 did so in an acute-care hospital, down from 32.6% who did so in 2000. Some 40% of these patients died in a home, hospice, assisted living facility or other community setting in 2015 — up from about 31% in 2000.

Those shifts took place during a period of sweeping changes in U.S. medical care.

As the 21st century got underway, palliative care gained a foothold in U.S. hospitals. This new medical specialty focused on improving the quality of life for very ill patients.

Then, with the adoption of the Affordable Care Act in 2010, hospitals adjusted to new rules aimed at improving the quality of care and reducing expensive patient readmissions.

A woman holds the hand of her husband, who is in hospice care. More Americans are opting to spend their final days outside of a hospital setting, according to a new study.

Meanwhile, doctors and hospitals began a vigorous reassessment of the way they cared for patients who were approaching the end of their lives. Studies chronicled many terminal patients’ tumultuous final days of treatments that were invasive, painful and futile. Other research toted up the traumatic stress experienced by surviving family members.

Physicians began to ask themselves and their patients whether their profession’s dedication to such “heroic measures” were saving patients’ lives — or poisoning their deaths.

In 2014, that debate culminated in a report by the National Institute of Medicine that defined a “good death” as one that is “free from avoidable distress and suffering for patients, families and caregivers” and “in general accordance with patients’ and families’ wishes.”

A patient’s death in the intensive care unit “is seldom viewed as a good death,” concluded the report, issued by the National Academies of Sciences, Engineering, and Medicine.

“There was a greater collective awareness that not all medical interventions are equally beneficial, and that the potential harms of some needed to be weighed,” said Dr. Diane E. Meier, a geriatrician and palliative care specialist who directs the Center to Advance Palliative Care and was not involved in the new research.

A greater focus on the comfort and values of seriously ill patients went hand in hand with the widespread adoption of palliative care teams in hospitals across the United States. These teams included specialists in pain management, mental health, legal and social work, and pastoral care, and they’ve been key in helping clarify what kind of lives — and deaths — patients with serious illnesses want. Then they help those patients and their families plan accordingly.

In 2000, fewer than 20% of hospitals with more than 50 beds had a palliative care team in place. By 2015, close to 70% of such hospitals did, according to a registry maintained by the Center to Advance Palliative Care.

“It’s impossible to say what’s at work here,” said Meier, who underscored that the new study shows a broad trend but does not delineate contributing factors. The changes came against the backdrop of significant shifts in insurance, institutions and professional practices, she said.

The analysis also yielded a wealth of small details about changing practices in end-of-life care.

For example, the study found that the use of hospice services by dying patients increased from 21.6% in 2000 to over 50% in 2015. And the proportion of patients in the study who died after getting only brief hospice services — for three days or fewer — dropped slightly, from 9.8% in 2009 to 7.7% in 2015.

The share of patients who had three or more hospitalizations in their last 90 days of life declined from 11.4% in 2009 to 7.1% in 2015. And the share of patients who spent part of their final four days on a ventilator fell from 3.1% in 2000 to between 2.5% and 2.7% by 2015.

Complete Article HERE!

A 2000-Year-Old Mummified ‘Sleeping Beauty’ Has Been Found Buried With a Mirror

Who was she?


Archaeologists in southern Siberia have unearthed a remarkable find – the mummified remains of a woman, carefully adorned in silk and buried with riches. Miraculously, her resting place was unscathed after being underwater for many years.

The team spotted the grave on the bank of the Yenisei River upstream of a giant dam – in a region that had been periodically underwater for decades.

She’s been nicknamed “sleeping beauty”, and was probably buried sometime in around the first century CE, archaeologists from St Petersburg’s Institute for the History of Material Culture believe.

Her burial place is near the Sayano-Shushenskaya Dam, which powers a hydroelectric power plant, and had been underwater for a great deal of time since the 1980s, when the reservoir began to be filled.

But her burial was unusual – she was laid to rest in a stone coffin – which is how her remains managed to survive being flooded.

“The mummy of a young woman was found inside a grave at the burial ground Terezin on the shore of a water reservoir. The lower part of the body is well-preserved,” explained archaeologist Marina Kilunovskaya of the Institute to Russian news agency TASS.

“It is not a classical mummy, though. The grave remained tightly sealed under the stone cover all along. The body underwent natural mummification.”

The waters recede every May and June, which allows archaeologists a short period of time to access the archaeological sites that were covered by the reservoir. They opened the tomb in May this year.

Inside, the burial was exceptionally well preserved. Soft tissues, skin, clothing and even grave goods were all found intact.

And the clothing and grave goods hint that the lady was a nomadic Hun, young and highly regarded by her people, possibly a noble.

“On the mummy are what we believe to be silk clothes, a beaded belt with a jet buckle, apparently with a pattern,” the Institute’s deputy director, Natalya Solovieva, told The Siberian Times.

“Near the head was found a round wooden box covered with birch-bark in which lay a Chinese mirror in a felt case.”

There were also two vessels buried with her, one of which was a typical Hun vase, both containing a funeral meal, and on her chest was a pouch of pine nuts. Ceramic utensils in the grave were typical of Hun burial practices, the archaeologists said.

Accidental mummification is not uncommon.

Ötzi the Iceman‘s body dehydrated, mummified by the ice of the glacier in which it resided for 5,000 years. The Gebelein mummies were naturally mummified by the heat, salinity and dryness of the Egyptian desert.

Bodies have even been found accidentally mummified by their copper grave goods.

Further work will need to be undertaken to determine exactly how the Sleeping Beauty was so well preserved. It’s also expected that analysis of her body and grave goods will reveal a lot about her culture, and her own life in particular.

The artefacts and body have been removed from the grave, and restoration experts have already started work to preserve them for posterity.

Complete Article HERE!

Managing grief with exercise

by Ernie Schramayr

Last month, my parents celebrated their 84th and 88th birthdays. At the same time, they were living with late-stage cancers and seemingly out of treatment options. After managing their diseases for over 15 years, they were fading fast and by the end of the month, both had passed away.

No matter your age or the circumstances, losing a parent is tough. Losing both of your parents in the same month, however, takes grief to a whole new level. I was somewhat prepared for their deaths, but, not really ready to navigate the different stages of grieving that I was about to go through, so I decided to just “keep busy” while the different emotions and physical feelings worked their way through my body and my mind.

One of the things that helped me endure these last few weeks was that I kept moving, sweating and exercising. At a time when it seemed like the world was out of control, going to the gym for a workout or to the trails for a bike ride gave me a sense that I actually did still have control over some things. It also gave me a sense of purpose when I really just felt like going to bed. As a matter of fact, when my sister called me with the news that my dad had passed away, I broke down … and then I worked out. To some it might seem a strange reaction but, to me, it felt comforting. It let me clear my head and gave me the ability to better deal with the actual event. After my workout, I breathed easier and then went home to cry some more and to break the news to the rest of my family.

In the throes of the intense emotions that come with grief, the instinct to isolate and withdraw can be overwhelming. I’ve experienced and given in to those feelings many times over the past month myself. There is no right or wrong way to go through the grieving process, and if being alone feels right, it probably is. There is one thing, however, that does seem to help virtually everyone that is in the process of dealing with emotional pain. That thing is exercise.

Aside from bringing a sense of purpose to your life, exercise triggers “feel good” chemicals in the body that elevate mood and result in increased blood flow, circulation and oxygen uptake. It also helps fight feelings of depression, anxiety, fatigue and even “brain fog,” and has been shown to minimize feelings of physical pain and insomnia and is important in helping to regulate appetite.

Exercising during the grieving process can help one regain motivation for work and other social commitments. While all activity is good and “just getting moving” is the right idea, working out at a high intensity can also move you to consider “What else can I take back?” when trying to get back to your “normal” life.

It goes without saying that I am writing this article based on my own personal experience. Exercising while dealing with intense emotion may not feel right for everyone. The thought of “getting going” might seem overwhelming, but for me it was just what the doctor ordered. Decide for yourself what is the best way forward, but consider the evidence that suggests that engaging in exercise while grieving is one of the best things you can do to make it through the process.

One final thought. While my family and I have been doing well during this trying time, there have been some pretty heavy “moments” and challenging days. I’ve learned to be kind to myself, and if a nap or a slice of pizza or glass of scotch feels right, I’ll skip the gym that day and make plans to pick it up the next. Having a plan and a sense of purpose means that; taking an extra day to mourn won’t turn into a week and then a month and then a year before getting things back on track. In the end, we’re all human and figuring things out as we go to the best of our abilities.

Complete Article HERE!

On death and dying: Do Jews have a choice?

by Martin J. Raffel

There is an old saying, attributed to Benjamin Franklin, that “in this world nothing can be said to be certain, except death and taxes.” Though loathe to get into discussion of the latter, said founding father was obviously correct about the former. At some point, all of us will face an end-of-life situation, and for those of us in New Jersey, the state might soon give us some degree of control over when and how we choose to die.

I refer to the Aid in Dying for the Terminally Ill Act, which is currently pending in the New Jersey state legislature. This legislation would allow physicians to provide life-ending medication to mentally competent patients who are at least 18 and have a terminal illness with a prognosis of, at most, six months to live. The patients must be able to self-administer the medication. Similar measures have passed in California, Montana, Vermont, Colorado, Hawaii, Washington State, and Washington, D.C. — all modeled on Oregon’s Death With Dignity Act enacted in 1997, the first of its kind.

“This option has brought sound public policy and improvements in end-of-life care to the states where it is permitted medical practice, and the time is now to bring the same quality of care to the people of New Jersey,” said Corinne Carey, N.J. campaign director of Compassion and Choices of New Jersey, Inc., the nonprofit, educational organization leading advocacy efforts. Sixty-three percent of the state’s residents support the measure, according to Carey.

I wondered whether there was a Jewish approach to what is sometimes referred to as physician-aided suicide. Not surprisingly, it depends on whom you ask.

I spoke with David Glicksman, an Orthodox rabbi with long-time pulpit and chaplaincy experience who currently serves on the Joint Chaplaincy Commission of the Jewish Federation of Greater MetroWest NJ. While he empathizes with the suffering of families, Glicksman said that because halacha (Jewish law) — which sees human life as sacred, clearly forbids suicide or assisting in suicide— he would oppose the pending legislation.

That said, “passive euthanasia,” the withholding of life-extending measures, as opposed to taking affirmative steps to end a life, is not necessarily a halachic violation. For example, he said, while actively removing a feeding tube or respirator would be unacceptable, one might not be required to replace a tube once it is removed.

But “if a patient asked me whether Jewish law permitted him or her to intentionally starve to death to end their suffering, I would have to answer in the negative.” Still, Glicksman said, he would “without judgment…comfort that patient as part of my pastoral responsibilities.”

On the other hand, Richard Address, a Reform rabbi and the director of Sacred Jewish Aging — a forum that promotes discussion about the revolution in longevity for baby boomers and their families — supports the legislation. “As a non-Orthodox rabbi, I view halacha as an evolutionary process, not rooted in an act of divine revelation,” he said. “Its genius is that it is a product of the social, political, economic, and religious context of the day.”

Address understands the portion of the verse in Deuteronomy 30:19 which states, “You shall choose life, so that you and your offspring will live,” to mean that “the ultimate decision of when to end life rests with me.” This is not a spur-of-the-moment decision, he said. “It’s a product of a lifetime and is driven by three factors: autonomy, the relationship with self; the impact of life-extending medical technology on quality of life; and one’s own spiritual beliefs.”

I speculated, and Address agreed, that it’s the baby boomer generation driving the momentum behind more liberal aid-in-dying laws. This is the generation that brought American society the sexual revolution and women’s liberation. Now that our parents’ generation is rapidly passing into history, we boomers have reached the ‘on deck’ circle and we’re aiming to change the culture on death and dying.

Rabbi Marc Kline of Monmouth Reform Temple — citing the 14th-century Catalonian Talmud scholar Rabbeinu Nissim, and Jewish bioethicist J. David Bleich — said, like Glicksman, that Jewish law prohibits taking active steps to hasten death. But their teachings, Kline said, support the option of praying for death as relief from an unbearable situation.

Stephanie Dickstein, speaking from experience — the Highland Park resident and Conservative rabbi works with older adults and end-of-life and bereavement issues — said, “It is not routine for families to be given emotional or practical preparation for the realities of caring for a loved one whose illness is reaching a terminal stage far enough in advance.” She does not believe the only choice is either using medical technology to extend life at all costs or allowing doctors to end life. “We can have policies and practices which make it the norm to support quality of life and comfort in the final chapter of life, rather than actively involving physicians in prescribing substances to end life.”

I also spoke with Jeff Feldman, advocacy coordinator of the North Brunswick-based New Jersey chapter of the National Association of Social Workers. His organization endorses the legislation, he told me, because “as a profession, social workers believe strongly in the value of self-determination for our clients. An individual with a terminal illness should be able to choose the time and method of their passing, rather than being placed at the mercy of their illness.” Social workers, he explained, often are the professionals with clients and their families during emotional end-of-life situations. “Hospice and palliative-care social workers…are called upon to non-judgmentally lay out for the client all of the available options,” and from his perspective, the more options available to the client, the better.

Just where do I stand? I’m with Address and the social workers in support of the pending legislation. Obviously, I agree with Dickstein that we should have a more effective palliative care system. But at the same time, not seeing myself as bound by a strict interpretation of halacha, I want a greater variety of end-of-life choices. That’s on a personal level.

On a societal level, I don’t think those whose religious or ethical beliefs regard the ending of life as immoral regardless of the circumstances should dictate our public policy.

No one likes to have these discussions, but, inevitably, such difficult medical and ethical decisions still have to be made. Whether you support or oppose this legislation, we all would be well served to thoroughly explore these issues not only with our loved ones, but in appropriate communal forums, as well.

Complete Article HERE!