Month: June 2020

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Sometimes a ‘Good Death’ Is the Best a Doctor Can Offer

Despite everything we do, we have lost so many battles with Covid-19

By Dr. Hesham A. Hassaballa

There has been so much clinician distress with the Covid-19 pandemic. So many physicians, nurses, and health care professionals have suffered physical, emotional, and moral difficulty taking care of severely sick patients. Some have even committed suicide.

As an ICU physician, I feel this firsthand and believe the reason for the anguish is that we, as critical care doctors and nurses and health professionals, are used to making a difference in the lives of our critically ill patients. Yes, we do lose some patients despite all that we do. But, for the most part, the majority of the patients we see and care for in the ICU get better and survive their critical illness.

Covid-19 has upended all of that.

Before Covid, I would not think twice about placing someone on a ventilator. It is a life-saving measure. With Covid, however, many patients who go on ventilators never come off. This is very distressing.

It is just so hard to try and try and try — spending many waking and sleeping hours — to help these patients pull through, only to have them die on you. Many times, the deaths are expected. Sometimes they are not, and those deaths are the most difficult to bear.

We are used to seeing death in the ICU. It is inevitable that some patients, despite all that we do, are going to die. With Covid, however, it is different. So many have died, and what makes it so hard is that these people are dying alone. Their families are only left to watch them die, if they so choose, on FaceTime or Skype. I’ve lost a daughter to critical illness. I cannot imagine the horror of not being able to be there at her side.

I was speaking to a fellow ICU doctor, and he told me that it seems all he is doing in the ICU is ensuring a “good death” for his patients, and this has deeply bothered him. He is not used to this amount of death. None of us are. It is very, very hard.

Is there any such thing as a “good death”?< It seems oxymoronic that the words “good” and “death” can be juxtaposed. As doctors, our whole existence is to prevent our patients from dying. So, in one sense, there is no such thing as a “good death.” To be sure, I have seen plenty of “bad deaths” in the ICU. Of course, those include patients whose death was unexpected. At the same time, there are patients who we know (despite everything we do) will not survive. In those cases, we do our best to make sure the patient does not suffer. If a patient dies while suffering pain or distress, or they get care that is not consistent with their values and wishes, then — to me, at least — this constitutes a “bad death.” But, indeed, there can be a “good death.”

None of us knows when or where we are going to die… If, however, we can die with comfort, without pain, without distress, and with complete dignity, then that is sometimes the best outcome.

As a doctor, especially an ICU doctor, it is awesome to see our patients do well and survive critical illness. It gives me an indescribable feeling of warmth and joy, and it is the fuel that keeps me going for a very long time. This joy has only been amplified during the Covid crisis. Watching one of our patients — who was very sick and I thought for sure going to die — walk out of the hospital on his own made me absolutely ecstatic.

Sadly, however, that experience has been fleeting with Covid, which has been so disheartening. Yet, even in death, there is an opportunity to do good. Even in death, we can do all that we can to ensure our patients die in peace, without pain, without suffering, and with the dignity they deserverecent study found that approximately 25% of patients experienced at least one significant pain episode at some point in the last day of life. More than 40% of patients experienced delirium. Delirium is an altered state of consciousness, and as ICU doctors, we work very hard to minimize this experience in our patients. In more than 22% of ICUs in America, there were high rates of invasive therapies at the time of death. Almost 13% of patients were receiving CPR at the time of their death, and more than 35% of patients died on a ventilator.

If getting CPR or being on a ventilator will only prolong suffering, or if either is not consistent with a patient’s wishes or values, then I — as their physician — must do everything I can to ensure this does not happen.

When I speak to families on the phone, trying to comfort them in the face of the death of their loved one, I promise this one thing: “I promise you that your loved one will not suffer. I promise you that I will make sure they are not in pain or in distress.” It doesn’t make the death of their loved one any easier, I know, but it is the absolute least I can do to make a horrible situation better.

None of us knows when or where we are going to die. Many (if not most) of us do not know what will cause our death. Those factors are beyond our control. If, however, we can die with comfort, without pain, without distress, and with complete dignity, then that is sometimes the best outcome. That is a “good death.”

And if it is inevitable that a patient will die, and I can help that patient die a “good death,” then that is my job. And in that duty, there is some good, some light, in the overwhelming darkness of this pandemic.

Complete Article ↪HERE↩!

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Refusing to give death the last word

Between the coronavirus and police killings, Black communities are coping with seemingly endless grief. The absence of funerals during the pandemic has been particularly devastating to a culture in which collective mourning plays a vital role.

Flag dancer Tinah Marie Bouldin performed at the memorial service of Kenneth O’Neal Davis Jr., 70, at the Whigham Funeral Home

By Nyle Fort

But the death toll only tells one side of the story. The other side is the anger of being unable to see or touch your deceased loved one for the last time. It’s “a different type of grief,” says Carolyn Whigham, my mother’s longtime partner and co-owner of Whigham Funeral Home in Newark, N.J. “This is where you snot. Cry. Stomp. Shout. Cuss. Spit.”

I asked Carolyn and my mom, Terry Whigham, about their experiences as Black undertakers during the coronavirus outbreak. The stories they shared speak to the scandalous nature of the pandemic. We’re not only grieving our dead. We’re grieving the inability to properly grieve.

This is not our new normal. This is the death of normal.

Terry Whigham (center) and Carolyn Whigham (left) worked with funeral home assistant Vernest Moore at the Whigham Funeral Home.

THERE WAS NEVER a dull moment growing up in a Black funeral home. After school, my brother and I played hide-and-seek between and inside caskets. Our chores included rolling old Star-Ledger newspapers used to prop up bodies for wakes. In the summers, when I wasn’t at basketball camp, I passed out peppermints and tissues to family members of the deceased. I knew I didn’t want to make a living burying the dead. But I was spellbound by the way we mourn.

Service after service I witnessed the electricity and elegance of Black grief. The adorned body laid out in an open casket. Elders dressed in their Sunday best tarrying and telling stories of the good ol’ days. Teenagers with a classmate’s face emblazoned on R.I.P. T-shirts. A spirited eulogy followed by a festive repast where soul food is served and family drama unfolds.

It’s a ritual of death transformed into a “celebration of life.”

For Black communities, who have been disproportionately affected by the coronavirus, bans on funerals have been particularly devastating. I understand why. Not only did I grow up in a Black funeral home, but I’m currently finishing my dissertation on African American mourning.

Burial traditions have long animated African American culture, politics, and resistance. During slavery, insurrectionists like Gabriel Prosser and Nat Turner plotted rebellions at slave funerals. A year before the Montgomery Bus Boycott, Mamie Till held an open-casket service for her slain son so “the world could see what they did to my baby.” The publication of the images of Emmett Till’s mutilated body, many historians argue, was the match that sparked the civil rights movement.

Ruthener Davis at the memorial service of her son, Kenneth O’Neal Davis Jr., who died from complications related to COVID-19.

Three years ago, white supremacist Dylann Roof walked into Mother Emanuel AME Church in Charleston, S.C., and slaughtered nine black parishioners. The day after President Barack Obama eulogized pastor and state senator Clementa Pinckney, activist Bree Newsome scaled a 30-foot pole at the South Carolina State House and removed the Confederate flag. “I was hoping that somehow they would have the dignity to take the flag down before his casket passed by,” she said in an interview after her arrest.

What does this have to do with the coronavirus? Black grief does not begin or end at the funeral procession regardless of how someone has died. Our dead live on in the food we eat, the songs we sing, the children we raise, the ballots we cast, the movements we build, and the dreams we struggle to make real. But how can African Americans work through the psychological wage of unfathomable grief without the sound of a Hammond B-3 organ, or tender touch of an auntie, or the smell of cornbread and candied yams, or the sight of our loved one’s beautified body?

“Could your big mama cook? Did you save any of her recipes?” Carolyn asks a family friend whose grandmother, who was known for her peach cobbler, passed away from COVID-19. “No, because it was all in how big mama did the crust,” the granddaughter explained.

“Well, maybe grandma couldn’t write down how to do the crust but did you stand over her shoulder and watch how she kneaded that flour?” Carolyn asks. She wants to make sure that what remains in the wake of loss doesn’t pass away with grandma.

The great poet and activist Amiri Baraka, whom my family funeralized in jazzy splendor, spoke to this in his book “Eulogies”: “I want to help pass on what needs to live on not just in the archive but on the sidewalk of Afro-America itself.”

How do we keep that tradition alive amid deserted sidewalks and overcrowded morgues? Hell, how do we keep ourselves alive as we witness, once again, Black death go viral?

The memorial service of Kenneth O’Neal Davis Jr., 70, who died from complications related to COVID-19, was live streamed at the Whigham Funeral Home.

I HEARD ABOUT the killing of Ahmaud Arbery the day after my friend’s father died of COVID-19. Then I heard about the killing of Breonna Taylor by police officers who burst into the wrong home to look for a suspect who was already in custody in Louisville, Ky. Then 21-year-old Dreasjon Reed and 19-year-old McHale Rose, two Black men killed by Indianapolis police within an eight-hour stretch. Then, before I could finish writing this story, George Floyd, another Black man, was killed by a white police officer, who pinned him to the ground for eight minutes as he pleaded for his deceased mother and yelled “I can’t breathe,” echoing Eric Garner’s last words.

I refuse to watch the videos of the killings of Ahmaud, Dreasjon, or George. I’ve seen the reel too many times. Different city, different cop, different circumstances. Same horror story. But when I heard that a detective in Indianapolis said “it’s going to be a closed casket, homie,” evidently referring to Dreasjon’s funeral, I lost it.

Unfortunately, I’m used to police playing judge, jury, and executioner. But this officer had the audacity to assume the role of an undertaker, too. It’s nauseating.

Black people are not only dying at alarming rates from the virus. We’re still dying from pre-existing conditions of racial injustice. There is no ban on police brutality during this pandemic. We are losing jobs and loved ones. Police are dragging us off buses for not wearing masks, while prison officials are withholding personal protective equipment to our loved ones behind bars.

Truth is: The pandemic is unprecedented but all too familiar. The endless grief hits close to home. In one year, my family buried my brother, father, and grandmother. My mom visits my brother’s crypt almost every day. Between funerals, she steals away and sits with his remains. For Thanksgiving she brings him pork chops smothered in gravy. His favorite. On the anniversary of his “transition,” as she likes to call it, she gives his shrine a makeover and sings Sam Cooke’s “A Change Gon’ Come.” Chad had an old soul.

A casket in a viewing room dedicated to Sally Alexander, Terry Whigham’s mother.

I last saw my brother on his 32nd birthday, four days before a heart attack took his last breath away. My memory of his funeral comes in shards. I remember the sound of the drums and the look on my mom’s face and me laughing quietly to myself at the idea that he had won our final game of hide-and-seek.

In the midst of our own grief, my family has provided dignified memorial services to Black people in New Jersey, including Sarah Vaughan, Amiri Baraka, Whitney Houston, and the countless beautiful lives whose names and stories don’t make national headlines. Like the daughter of the woman who banged on the funeral home window. A week later, the woman held her shirt still as my mom, standing a short distance away in personal protective equipment, pinned a brooch that contained a photo of her daughter who’d just been cremated.

The woman wept and said, “It’s the little things that mean so much.”

She’s right. A spirit of care and compassion sits at the heart of our heroic efforts to stay alive, too.

Organist and singer Joshua Nelson performed during a memorial service.

In the midst of all of the death and violence, Black people continue to fight back, risking our lives to save others. I witnessed hundreds of protesters wearing face masks chanting “Whose streets? Our streets!” at the intersection of West 62nd Street and Michigan Road in Indianapolis, where Dreasjon was shot and killed. I thought about the residents of Canfield Drive in Ferguson, Mo., who, before Mike Brown’s blood had dried, planted flowers between teddy bears and empty liquor bottles to commemorate his death. I pictured Bree bringing down the Confederate flag, and the heartaches and heartbeats of Black joggers as they “ran with Ahmaud.” Today, I marvel at the bravery of people across the country protesting George’s killing and resisting patterns of police violence amidst the deadliest pandemic in over a century.

Even Carolyn and my mother — who don’t consider themselves activists — provided a hearse for a funeral procession protest honoring the memory of the 45 inmates who have died from the virus in New Jersey prisons.

My family’s funeral home embodies the incredibly essential work before us all today: burying our dead while refusing to let death have the last word.

Complete Article ↪HERE↩!

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Dying virtually

– Pandemic drives medically assisted deaths online

The late Youssef Cohen moved from New York to Oregon in 2016 because of its aid-in-dying law. During the pandemic, assisted dying for terminal patients has gone online.

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The coronavirus has stripped many of a say in the manner and timing of their own deaths, but for some terminally ill people wishing to die, a workaround exists. Medically assisted deaths in America are increasingly taking place online, from the initial doctor’s visit to the ingestion of life-ending medications.

Assisted dying laws allow terminally ill, mentally competent patients in 10 U.S. jurisdictions to hasten the end of their life. Waiting periods of 15 to 20 days mean that patients with acute COVID-19 won’t likely meet the requirements of these laws.

But the move to digitally assisted deaths during the pandemic has enabled other qualified patients to continue to exercise the right to die. While telemedicine is helping some people die on their own terms, it also makes the process harder on family members, who must now take a more active role in their loved one’s final act.

Assisted dying in America

I have spent the last four years studying assisted dying in America, particularly in Oregon and Washington, which have the country’s longest-standing assisted dying laws. California, Colorado, the District of Columbia, Hawaii, Maine, Montana, New Jersey and Vermont also allow medical assistance in dying.

A quirk in these laws has enabled the process to go virtual. While extremely restrictive in most ways, U.S. assisted dying laws don’t require a physician or other health care provider to be present at an assisted death.

Assisted dying laws require two doctors to independently evaluate a patient’s request for medical assistance in dying. But patients must be physically able to ingest the life-ending medication themselves, a safeguard that ensures they are acting voluntarily.

In Canada, by contrast, clinicians typically administer the lethal dose through an injection. Normally that’s a faster, safer and more effective method. But COVID-19 concerns are compelling some Canadian providers to suspend assisted deaths.

Attending to the dying

Though U.S. physicians aren’t required to attend an assisted death, many patients and their families do have help. In 2019, according to the Oregon Health Authority, 57% of all assisted deaths in Oregon were attended by a physician, another health care provider or a volunteer.

Trained volunteers – many of them former nurses, social workers and behavioral health experts – are critical in helping patients navigate the tricky path toward an assisted death. They know which physicians are willing to see aid-in-dying patients and which pharmacies stock the necessary medications.

In the United States, doctors prescribe a compound of four drugs – digoxin, diazepam, morphine and amitriptyline – to be mixed with water or juice. Within minutes of drinking the cocktail, the patient falls asleep, the sleep progresses to a coma, and eventually the patient’s heart stops.

Volunteers help mix the medication and supervise the ingestion, allowing families to be emotionally present with a dying loved one.

Now, because of the coronavirus, volunteers are accompanying patients and families over Zoom, and physicians complete their evaluations through telemedicine, based on recommendations released by the American Clinicians Academy on Medical Aid in Dying in March 2020.

Telehealth – a health care solution long used in remote areas – has become a critical tool of the COVID-19 pandemic. But some aid-in-dying physicians have drawn on telemedicine to reach far-flung patients for years.

“My patients love telemedicine,” Dr. Carol Parrot, a physician who lives on an island in Washington, told me during a Skype interview in 2018. “They love that they don’t have to get dressed. They don’t have to get into a car and drive 25 miles and meet a new doctor and sit in a waiting room.”

Parrot says she sees 90% of her patients online, visually examining a patient’s symptoms, mobility, affect and breathing.

“I can get a great deal of information for how close a patient is to death from a Skype visit,” Parrot explained. “I don’t feel badly at all that I don’t have a stethoscope on their chest.”

After the initial visit, whether in person or online, aid-in-dying physicians carefully collate their prognosis with the patient’s prior medical records and lab tests. Some also consult the patient’s primary physician.

‘Tough and tender situations’

The pivot to telemedicine hasn’t significantly changed that process. But patient advocacy organizations and physicians say the pandemic has amplified existing problems of access to assisted dying.

“These are tough and tender situations even without COVID,” said Judy Kinney, executive director of the volunteer organization End of Life Washington, via email.

Invariably, some terminally ill patients who wish to die face barriers. Some assisted living and nursing facilities have policies against assisted dying for religious reasons.

During the pandemic, residents in these institutions who lack access to a digital device – or the skills to videoconference with a doctor – may not be able to qualify for the law, according to Dr. Tony Daniels, a prescribing physician from Portland.

Meanwhile, a family member who objects to assisted dying may more easily undercut the process when a volunteer isn’t there in person to make sure a patient’s final wishes are carried out.

Facilitating death

Dying via telemedicine can be hard even on family members who stand behind their loved one’s decision, my research finds. Without a volunteer or physician present, families must assume a more active role in the dying process.

That includes mixing the life-ending medications themselves. Pre-pandemic, many families told me that preparing the lethal cocktail would make them feel like they were facilitating – and not just morally supporting – a loved one’s death. They were glad to outsource this delicate task.

Now they don’t have that choice.

Yet the option to assist in a loved one’s final act may be a comfort in this pandemic. It allows dying people to choose the manner and timing of their own death – and ensures they won’t be alone.

Complete Article ↪HERE↩!

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How COVID-19 May Reframe End-of-Life Care Planning Engagement

The COVID-19 pandemic has renewed patient appreciation for end-of-life care planning, pushing providers to explore best practices for engaging these conversations.

By Sara Heath

For years, the concept of end-of-life care planning has been elusive to intensive care unit (ICU) providers. Not a lot of patients have engaged in these types of communications, and it hasn’t been hard to see why: end-of-life care planning is by nature a grim topic and can make a lot of people — including clinicians — feel uncomfortable.

But that’s started to change now that the COVID-19 pandemic has gripped the nation. At this point, over 100,000 people have died from the novel coronavirus, and it’s pushed end-of-life care planning as a key topic of conversation.

“The virus and the pandemic shined an important light on end-of-life care planning and the need for people who don’t have medical problems to still consider what their wishes would be. That’s because this virus can unfortunately strike folks who are healthy,” said Lauren Van Scoy, MD, a pulmonary and critical care physician at Penn State.

The number of patients coming into the ICU with an advance directive or having discussed some kind of end-of-life wishes with their family members of providers was scant prior to the pandemic. Patients and providers alike have long been uncomfortable with these types of conversations, largely because talking about death can be difficult and scary.

Per 2016 data, many hospitals don’t have much of a protocol for engaging patients in advance care planning or recording end-of-life wishes. Meanwhile, just under half of providers are uncomfortable with addressing the topic with their patients because they are unsure of what to say, the survey out of the John A. Hartford Foundation, the California Health Care Foundation, and Cambria Health Foundation revealed.

Several providers said that they struggle with identifying the proper time to broach care planning with their patients. Forty-eight percent of providers didn’t want their patients to think that they were giving up on them, and 46 percent didn’t want their patients to give up hope.

But this lack of advance care planning between patient and provider or patient and family member can have negative consequences down the line. For the patient, it decreases the likelihood she will receive hospice care at the end of her life and increases the odds she will receive intensive therapies, which can be both costly and unwelcomed by the patient.

And for the family, limited understanding of a loved one’s end-of-life care wishes can lead to serious distress.

“Care planning is so important because not only does it help the patient to receive care that’s consistent with their wishes, but it also helps the family members to have a lower-stress experience,” Van Scoy explained. “They have less psychological morbidities afterwards, and less stress related disorder.”

The data show that up to 30 percent of families who have to make end-of-life decisions experience post-traumatic stress disorder symptoms, Van Scoy pointed out, referencing a seminal study published in American Journal of Respiratory and Critical Care Medicine.

“That’s one of the things that advanced care planning can help to reduce the likelihood of, the stress related symptoms, so that’s why it’s really important for both the patient and the family,” she added.

Of course, advance care planning hasn’t totally been unheard of. In 2015, CMS said it would start paying Medicare providers for holding advance care planning talks with patients, with the goal of improving the quality and experience of end-of-life care and potentially decreasing the use of costly and intensive therapies. Increasing reimbursement for these activities potentially served as an incentive to increase engagement.

And older adults, knowing they may be nearing the end of their lives, have also been at least somewhat receptive to these conversations.

“As people get older, they’re more likely to do advanced care planning,” Van Scoy said, suggesting that this is not enough.

“As we know, medical catastrophe can happen for anyone of any age. We’re often faced with patients, particularly in the ICU, who have not had conversations about what their goals are, what their wishes are, what their preferences are. Families are often quite distressed when having to make decisions.”

But again, that trend has started to change, as more Americans face the reality that they could contract the novel coronavirus. And although COVID-19 has a pronounced impact on individuals with comorbidities, the fact of the matter is anyone could succumb to it.

“The virus has given us an opportunity to have that teachable moment to show that, whether you were diagnosed with coronavirus, or have cancer or a car accident, or some other sort of acute and unexpected illness, it’s always good to have good care planning done in advance,” Van Scoy stated.

“The coronavirus pandemic has allowed people to think about it in a new context as opposed to, ‘advanced care planning is just for old and sick people, not for me,’” she continued. “Now we’re having a conversation nationally about ventilators and ICU use and people needing emergency critical care. People are thinking, ‘gosh, I very well could end up on a ventilator.’ The coronavirus has changed the conversation to be more relevant, more pertinent, and brought it to a broader scope of Americans, not just elderly or those with illness.”

And while patients and providers alike are facing a renewed appreciation for advance care planning, Van Scoy has uncovered new strategies to make these conversations more palatable. After all, just because more patients recognize the need for advance care planning doesn’t make these conversations any less uncomfortable.

As part of her research on patient experience and communications in the ICU, Van Scoy has developed a game that brings advance care planning into the community in an agreeable way. The game, titled Hello, can be delivered in both the healthcare facility or in a community-based setting as it pushes patients to consider what is important to them at the end of their lives.

“The Hello tool is a game that allows patients and their families and friends to come together and talk in a way that’s sort of less serious and less intrusive,” Van Scoy explained. “The game features questions that are asked in a way that are easy to answer. Questions are things like ‘what music would you want to be listening to on your last day of life’ or ‘what are three non-medical facts that your doctors should know about you.’ It approaches this topic in a very soft way, but yet it’s still getting into the meat of the problem.”

And the qualitative data shows this approach has been effective, especially in traditionally marginalized populations for whom end-of-life care planning is even less prevalent. Van Scoy largely credits this to the community-based setting in which she has deployed Hello.

“We leverage those networks to get individuals set up to have these conversations in places outside the healthcare system,” Van Scoy noted. “Users are comfortable and they can lean on each other as opposed to leaning on the healthcare system, which in underserved populations have had some historic problems with trust.”

This new information about carrying out advance care planning will be essential going forward, as the COVID-19 crisis ideally renews patient and provider appreciation for these conversations. As the healthcare industry works to adapt to the novel coronavirus, understanding the best ways to address end-of-life wishes will help providers treat their ailing patients with dignity.

Complete Article ↪HERE↩!

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Coronavirus reminds you of death

– and amplifies your core values, both bad and good

Gustav Klimt’s ‘Death and Life’ suggests the way many people are unaware of death’s ever-present influence.

By &

There’s nothing like a worldwide pandemic and its incessant media coverage to get you ruminating on the fragility of life. And those thoughts of death triggered by the coronavirus amplify the best and worst in people.

The results of this psychological phenomenon are all around: people hoarding toilet paper and hand sanitizer, hurling ethnic slurs and attacking Asian Americans, heaping praise or scorn on President Trump, hailing new political and health care heroes. Sheltering at home has drawn some families closer together, but is a crucible of domestic violence for others. For many, social distancing has increased feelings of isolation, boredom, anxiety and despair.

What’s behind these attitudinal and behavioral shifts?

Back in 1986, we first developed an idea called terror management theory that explains how people double down on their essential beliefs, without even noticing, when confronted with their own mortality.

Hundreds of psychology experiments from the past 30 years have explored how people react to the thought of their own death. These reminders bolster people’s core worldviews, making racists more hateful, the religious more devout, the charitable more giving and constituents more suportive of charismatic leaders.

At a moment when the idea of death is front and center for many people, this psychological tendency has important implications for everything from how grocery store cashiers are treated to how people will vote in the upcoming presidential election.

No one gets out alive

Terror management theory acknowledges that human beings are animals biologically predisposed to try to survive. But at the same time, people also realize how dangerous the world is, how vulnerable we are and that ultimately the quest for continued existence is doomed to fail.

Knowing that we will all die, and it can happen at any time, can give rise to potentially paralyzing terror. To manage this fear, people work to see themselves as valuable contributors to a meaningful universe. Viewing yourself as an important worker, entrepreneur, teacher, artist, scientist, lawyer, doctor, parent, spouse and so forth allows you to feel like you’re not just a material creature who will disappear upon death.

Rather than dwelling on that disturbing thought, you can believe in things like immortal souls, in your offspring carrying on your genes and values or in your work having an enduring impact. It’s comforting to believe that some part of you will continue after death, through your connections to your family, profession, religion or nation.

Thoughts of death lead people to cling more tightly to these soothing beliefs. Such thoughts can be triggered by simply reading a news story about a murder, being reminded of 9/11 or even glancing at a funeral home sign.

Death reminders first trigger immediate, front-line defenses – you want to feel safe by getting death out of your mind right away. Then subconscious downstream defenses work to fortify the protective bubble of the symbolic reality you believe in. Researchers have found that these downstream defenses include more punitive reactions to criminals, increased rewards for heroes, prejudice toward other religions and countries and allegiance to charismatic politicians.

Pandemic provides nonstop reminders of death

Because of the coronavirus, death reminders are all around. Front-line reactions range from efforts to shelter at home, maintain social distancing and wash hands frequently to dismissing the threat by comparing it to the flu or calling it a political hoax meant to undermine the economy and thwart President Trump’s reelection effort.

People who are more optimistic about their coping skills and have confidence in health care providers are prone to react constructively. They typically follow the recommendations of health care experts.

But people prone to pessimism and skepticism regarding health care authorities are more likely to deny the threat, ignore recommendations and react hostilely to expert advice.

These first-tier defenses banish death thoughts from consciousness, but do not eliminate their influence. Instead the thoughts linger just outside your attention, triggering downstream defenses that reinforce your valuable place in your world.

One way to enhance your value is through contributing to and identifying with heroic efforts to defeat this threat. That can happen via your own behavior and by lauding those leading the charge, such as first responders, health care workers, scientists and political leaders. Even those who inhabit social roles not usually given their due are recognized as heroes: grocery cashiers, pharmacists and sanitation workers.

At the same time, many people question their value more because of the pandemic. Earning a living to provide for one’s family and connecting with others are fundamental ways to feel valuable. Pragmatic health and economic concerns and impoverished social connections can combine to threaten those feelings of meaning and value. In turn they can increase levels of anxiety, depression and mental health problems.

Existentially threatening times also tend to create heroes and villains. American scientists, like Anthony Fauci, and political figures, like New York Governor Andrew Cuomo, are more widely admired. President Trump’s approval rating temporarily increased. In times of crisis, people typically turn to their leaders, and put additional faith in them.

At the same time, people also seek to assign blame. Some turn their fear and frustration about the coronavirus that first emerged in China into hate toward Asians and Asian Americans. Others, depending on their political leanings, blame the World Health Organization, the mainstream media, or President Trump.

Even if the coronavirus abates, thoughts of mortality will linger on the fringes of consciousness as the November election approaches. If President Trump is perceived as a heroic wartime president who got the country through the worst of this invisible enemy, such death reminders could work to his advantage.

If, however, the president is viewed as an incompetent bungler responsible for the virus spreading and the economy collapsing, the same death reminders could undermine his chances.

We’re all in this together

If you’re interested in trying to short-circuit some of these unconscious defenses, our research suggests a few promising possibilities. Maybe the best approach is to consciously acknowledge your mortal fears. By doing so, you can gain some reasoned control over their influence on your judgments and behavior.

We also suggest keeping in mind that all human beings are one interdependent species sharing the same planet. Recognizing that the coronavirus poses the same existential threat for all of us helps underscore that humanity is a group we all belong to. It’s by working together and not turning on each other that we will be able to recover our economic, physical and psychological vitality.

Complete Article ↪HERE↩!

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I’m an oncologist with terminal cancer, and I support medical aid in dying.

Here’s why.

As my cancers progress, I want to be in charge. I want the legal option to die, if need be, before it is too late to consent to my own death.

By Dr. Tom R. Fitch

Remarkable advances in medical care are helping us live longer. But that means there also are an increasing number of people living with advancing serious illness.

The vast majority understand they are living with a terminal condition, yet they and their families are unprepared for the final stages of life. Relatively few have had discussions with their physicians about their prognosis and end-of-life care options. Their wishes and goals are not discussed, and no meaningful informed consent regarding further disease-directed treatments is provided.

“Let’s try this,” becomes the default recommendation, and patients are commonly led down a path of relentless disease-directed therapies of limited to no benefit. Tragically, more treatment too often results in more suffering and shortened survival.

With the expert end-of-life care currently available, dying and death can be meaningful and peaceful for many. But to believe all deaths are “natural” – peaceful and without suffering – is just wrong.

I cared for patients with cancer for more than 30 years and increasingly provided palliative and hospice care over the final 17 years of my career. I saw agonizing deaths despite my best efforts, and it was not rare for patients to ask me how I might help accelerate their dying. That, however, was not an option in either Minnesota or Arizona where I practiced.

Patients must understand their options

Now, I too am faced with terminal illness. I have multiple myeloma and non-Hodgkin’s lymphoma, and despite aggressive care, I have not achieved remission. My cancers are incurable.

I contemplate dying and my death and those thoughts include consideration of medical aid in dying. I do not know if I would ever self-administer a lethal dose of medications, but I pray that the option is available for me.

I do know that we must help patients and families overcome the taboo of discussing their prognosis, dying and death. We need to facilitate meaningful end-of-life care conversations among patients, their families and health-care providers; promote the completion of advance directives; and encourage discussions of patients’ wishes, goals and values.

Patients and families must be informed of the many end-of-life care options available – including the expertise of palliative care and hospice providers, discussions regarding the possibility of stopping disease-directed therapies, withholding or withdrawing more advanced supportive care and/or devices, voluntarily stopping eating and drinking, and palliative sedation.

Patients near the end of their life also should have access to medical aid in dying (MAID).

What medical aid in dying laws do

I fully respect the conscience of those who oppose MAID; they are opposed for passionately held personal beliefs and values. I simply ask that they similarly respect my strongly held beliefs and values.

Guidance in the American Medical Association Code of Medical Ethics understands this divide: “it encompasses the irreducible moral tension at stake for physicians with respect to participating in assisted suicide. Supporters and opponents share a fundamental commitment to values of care, compassion, respect, and dignity; they diverge in drawing different moral conclusions from those underlying values in equally good faith.”

MAID is now legal in nine states and the District of Columbia, available to more than 70 million residents. After nearly 50 years of real-word experience, there has been no evidence of the “slippery slope” or “increased societal risk” opponents routinely cite.

We have seen no indication of a heightened risk for women, the elderly, poorly educated, the disabled, minorities, minor or those with mental illness. There has been no rising incidence of casual deaths and no evidence to suggest that MAID has harmed the integrity of medicine or end-of-life care.

MAID laws clearly provide adequate safeguards and allow for the position of dissenting physicians. The laws respect their conscience and give the right to any physician not to participate.

This is patient-centered care

Those of us who support MAID are asking for the same – respect for our conscience and considered judgment. We do not believe we are doing harm. We are caring for a competent adult who has a terminal illness with a prognosis of six months or less. We are providing patient-centered care consistent with the patient’s wishes, goals, beliefs and values – helping that patient avoid protracted, refractory and avoidable suffering.

One false narrative espoused by opponents – that “participation in MAID is suicide” – needs to be addressed. Participants do not want to die. They have a progressive terminal illness, and meaningful, prolonged survival is no longer an option.

They have full mental capacity with an understanding of their disease, its expected course and their prognosis. They have the support of their family. They feel their personhood is being destroyed by their illness, and they want their death to be meaningful and peaceful.

None of this is true for people who die by suicide.

Personally, I no longer struggle with the ethics, morality and other controversies surrounding MAID. Ethical principles and moral laws alone are just not sufficient to answer the complex questions surrounding an individual’s dying and death.

Our diverse country and our Constitution forbid us from imposing our own religious and faith beliefs on others. When we try, we are forcing others to conform to our beliefs and we are turning a blind eye from truly seeing the very real human suffering that is in front of us.

It is devastating for patients if we ignore their life stories, their family, their culture, and the impact of their disease and treatment on their life and well-being. The value of their life, as they define it, has vanished and they want to die on their own terms.

This is not a challenge to God’s divine sovereignty but a challenge to the disease itself. Patients are vowing that it will no longer be in charge.

As my cancers progress, I too want to be in charge. I want the legal option to die, if need be, before it is too late to consent to my own death. I desperately want to avoid recruitment into that borderland where I would vegetate as neither here nor there.

I ask for your unconditional trust and I ask that those opposed to MAID for themselves, respect my prayerful discernment and personal requests for end-of-life care as I believe it is consistent with my needs, beliefs and values.

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