Asian Elephants display complex mourning rituals similar to humans

By

Elephants are smart animals with strong feelings and they often work together. In India’s Bengal area, scientists found that elephants buried five baby elephants, according to a study published in the Journal of Threatened Taxa.

Researchers have limited the study of elephant thanatology—the examination of death and related practices— to the burial of calves. Observers had noted this aspect of behaviour in African elephants but had not documented something similar in Asian elephants until recently, despite both species diverging 4.2 million years ago.

The researchers wanted to clear up the second question – do Asian elephants, like African elephants, mourn their dead calves? And the answer is yes, and it is loud. The vocalizations from the elephants lasted between 30 and 40 minutes, but only in places far from human settlements.

They point out that this behaviour suggests elephants distinguish human spaces from non-human spaces to avoid disagreements. They also mention that elephants limited vocalisation to the burial phase.

The increasing encroachment of human activities into natural habitats and the resulting environmental degradation are forcing elephants to venture into human-dominated areas in search of food and other ecological necessities. This interaction has led to new behaviours in these majestic creatures.

Asian Elephants’ mourning behaviour

Parveen Kaswan, an officer with the Indian Forest Service, and Akashdeep Roy, a researcher at the Indian Institute of Science Education and Research, spent 16 months reviewing literature relating to elephant burials. They found five case reports that document this behaviour.

An elephant calf was buried on a tea estate with its feet visible.

Researchers have revealed that Asian elephants, similar to their African counterparts, engage in what we can describe as mourning rituals. Observations showed them vocalising loudly and burying their deceased calves, exhibiting a level of ritualistic behaviour that parallels human funeral rites.

The study reports a heartbreaking journey of a mother elephant. The mother elephant carried her dead calf for two days before letting it go. This extended time of grieving shows the deep attachment between mother elephants and their offspring. This could have been made stronger possibly by hormonal influences like oxytocin and the long gestation period elephants experience. This response is consistent with other studies on chacma baboons, olive baboons, African elephants and Thornicroft’s giraffes.

As per the study, the burial process is a collective effort, involving not only the mothers but also other females within the herd who act as surrogate caregivers, as well as elephants of various ages. This communal participation underscores the intricate social fabric of elephant herds and their collective mourning when faced with death. Notably, this ritualistic burial is reserved exclusively for the young. The physical impracticality of carrying the larger, heavier adults precludes them from receiving the same rite. This selective practice indicates that the elephants’ mourning and burial customs are particularly significant for the young, whose passing deeply impacts the social structure of the herd.

Compassionate behaviour

The research aimed to understand the ‘perimortem’ strategy and ‘postmortem’ behaviour of Asian elephants. The main evidence shows that someone or something transported the corpses from afar, treated with great care. They buried the corpses in preferred locations, always in a specific posture, which was an unusual lying position with legs upright.

The author said, “Our study found an interesting thing – the placement of carcasses with their paws raised in narrow irrigation drains. This strategic behaviour shows the care and affection of herd members toward the deceased animal and suggests that in a potential crush situation, pack members prioritize the head over the feet,” they highlight.”

“Elephants are social and affectionate animals and, based on an external examination of the carcasses, we also suggest that herd members gently placed the dead calves by grasping one or more legs,” the experts conclude.

The authors of the report thoroughly investigated the underlying reason for the death of the offspring through postmortem examinations. One of the conclusions is that there was no direct human intervention in any of the five deaths.

A buried carcass corresponding to case 3 of Bharnabaritea estate.

“Through direct and indirect evidence, this study highlights compassionate and helpful elephants’s behaviour during carcass burial. Asian elephants transport their deceased calves to isolated places, away from humans and carnivores, while searching for drains irrigation and depressions to bury the body,” the report states.

No infanticide among Asian elephants

Many animal groups, such as monkeys, meat-eaters, and rodents, commit infanticide or baby killing. Different reasons, such as elimination of competition, scarcity of resources, or maintaining social order within a group, contribute to this phenomenon.

However, the researchers found that there was no infanticide among the Asian elephants. They believe there are a few reasons why elephants don’t kill babies:

  • Elephants, particularly females and their young, live in close family groups forming strong bonds. This closeness possibly prevents them from hurting the young, actively encouraging them to cooperate in caring for them.
  • Baby elephants require long term care from their mothers and other females in the herd. This extended care and help from everyone might decrease the likelihood of someone killing a baby.
A buried carcass corresponding to case 2 of Chunabhatitea estate.
  • In the breeding process, elephants reproduce without having to kill their babies to quicken the mother’s readiness for another offspring. Unlike some other animals, the mother cannot immediately have another offspring if she loses a baby. Thereby, eradicating the need for males to kill babies.
  • Male elephants neither directly contribute to raising the babies nor participate in the close female groups. They prioritize finding females ready to mate rather than assuming control over a herd and eliminating other males’ babies. This social structure and breeding style decreases the likelihood of elephants killing babies.

Complete Article HERE!

What Deathbed Visions Teach Us About Living

— Researchers are documenting a phenomenon that seems to help dying people, as well as those they leave behind.

By Phoebe Zerwick

Chris Kerr was 12 when he first observed a deathbed vision. His memory of that summer in 1974 is blurred, but not the sense of mystery he felt at the bedside of his dying father. Throughout Kerr’s childhood in Toronto, his father, a surgeon, was too busy to spend much time with his son, except for an annual fishing trip they took, just the two of them, to the Canadian wilderness. Gaunt and weakened by cancer at 42, his father reached for the buttons on Kerr’s shirt, fiddled with them and said something about getting ready to catch the plane to their cabin in the woods. “I knew intuitively, I knew wherever he was, must be a good place because we were going fishing,” Kerr told me.

As he moved to touch his father, Kerr felt a hand on his shoulder. A priest had followed him into the hospital room and was now leading him away, telling him his father was delusional. Kerr’s father died early the next morning. Kerr now calls what he witnessed an end-of-life vision. His father wasn’t delusional, he believes. His mind was taking him to a time and place where he and his son could be together, in the wilds of northern Canada. And the priest, he feels, made a mistake, one that many other caregivers make, of dismissing the moment as a break with reality, as something from which the boy required protection.

It would be more than 40 years before Kerr felt compelled to speak about that evening in the hospital room. He had followed his father, and three generations before him, into medicine and was working at Hospice & Palliative Care Buffalo, where he was the chief medical officer and conducted research on end-of-life visions. It wasn’t until he gave a TEDx Talk in 2015 that he shared the story of his father’s death. Pacing the stage in the sport coat he always wears, he told the audience: “My point here is, I didn’t choose this topic of dying. I feel it has chosen or followed me.” He went on: “When I was present at the bedside of a dying person, I was confronted by what I had seen and tried so hard to forget from my childhood. I saw dying patients reaching and calling out to mothers, and to fathers, and to children, many of whom hadn’t been seen for many years. But what was remarkable was so many of them looked at peace.”

The talk received millions of views and thousands of comments, many from nurses grateful that someone in the medical field validated what they have long understood. Others, too, posted personal stories of having witnessed loved ones’ visions in their final days. For them, Kerr’s message was a kind of confirmation of something they instinctively knew — that deathbed visions are real, can provide comfort, even heal past trauma. That they can, in some cases, feel transcendent. That our minds are capable of conjuring images that help us, at the end, make sense of our lives.

Nothing in Kerr’s medical training prepared him for his first shift at Hospice Buffalo one Saturday morning in the spring of 1999. He had earned a degree from the Medical College of Ohio while working on a Ph.D. in neurobiology. After a residency in internal medicine, Kerr started a fellowship in cardiology in Buffalo. To earn extra money to support his wife and two young daughters, he took a part-time job with Hospice Buffalo. Until then, Kerr had worked in the conventional medical system, focused on patients who were often tethered to machines or heavily medicated. If they recounted visions, he had no time to listen. But in the quiet of Hospice, Kerr found himself in the presence of something he hadn’t seen since his father’s death: patients who spoke of people and places visible only to them. “So just like with my father, there’s just this feeling of reverence, of something that wasn’t understood but certainly felt,” he says.

During one of his shifts, Kerr was checking on a 70-year-old woman named Mary, whose grown children had gathered in her room, drinking wine to lighten the mood. Without warning, Kerr remembers, Mary sat up in her bed and crossed her arms at her chest. “Danny,” she cooed, kissing and cuddling a baby only she could see. At first, her children were confused. There was no Danny in the family, no baby in their mother’s arms. But they could sense that whatever their mother was experiencing brought her a sense of calm. Kerr later learned that long before her four children were born, Mary lost a baby in childbirth. She never spoke of it with her children, but now she was, through a vision, seemingly addressing that loss.

In observing Mary’s final days at Hospice, Kerr found his calling. “I was disillusioned by the assembly-line nature of medicine,” Kerr told me. “This felt like a more humane and dignified model of care.” He quit cardiology to work full time at the bedsides of dying patients. Many of them described visions that drew from their lives and seemed to hold meaning, unlike hallucinations resulting from medication, or delusional, incoherent thinking, which can also occur at the end of life. But Kerr couldn’t persuade other doctors, even young residents making the rounds with him at Hospice, of their value. They wanted scientific proof.

At the time, only a handful of published medical studies had documented deathbed visions, and they largely relied on secondhand reports from doctors and other caregivers rather than accounts from patients themselves. On a flight home from a conference, Kerr outlined a study of his own, and in 2010, a research fellow, Anne Banas, signed on to conduct it with him. Like Kerr, Banas had a family member who, before his death, experienced visions — a grandfather who imagined himself in a train station with his brothers.

The study wasn’t designed to answer how these visions differ neurologically from hallucinations or delusions. Rather, Kerr saw his role as chronicler of his patients’ experiences. Borrowing from social-science research methods, Kerr, Banas and their colleagues based their study on daily interviews with patients in the 22-bed inpatient unit at the Hospice campus in the hope of capturing the frequency and varied subject matter of their visions. Patients were screened to ensure that they were lucid and not in a confused or delirious state. The research, published in 2014 in The Journal of Palliative Medicine, found that visions are far more common and frequent than other researchers had found, with an astonishing 88 percent of patients reporting at least one vision. (Later studies in Japan, India, Sweden and Australia confirm that visions are common. The percentages range from about 20 to 80 percent, though a majority of these studies rely on interviews with caregivers and not patients.)

In the last 10 years, Kerr has hired a permanent research team who expanded the studies to include interviews with patients receiving hospice care at home and with their families, deepening the researchers’ understanding of the variety and profundity of these visions. They can occur while patients are asleep or fully conscious. Dead family members figure most prominently, and by contrast, visions involving religious themes are exceedingly rare. Patients often relive seminal moments from their lives, including joyful experiences of falling in love and painful ones of rejection. Some dream of the unresolved tasks of daily life, like paying bills or raising children. Visions also entail past or imagined journeys — whether long car trips or short walks to school. Regardless of the subject matter, the visions, patients say, feel real and entirely unique compared with anything else they’ve ever experienced. They can begin days, even weeks, before death. Most significant, as people near the end of their lives, the frequency of visions increases, further centering on deceased people or pets. It is these final visions that provide patients, and their loved ones, with profound meaning and solace.

Kerr’s latest research is focused on the emotional transformation he has often observed in patients who experience such visions. The first in this series of studies, published in 2019, measured psychological and spiritual growth among two groups of hospice patients: those who had visions and a control group of those who did not. Patients rated their agreement with statements including, “I changed my priorities about what is important in life,” or “I have a better understanding of spiritual matters.” Those who experienced end-of-life visions agreed more strongly with those statements, suggesting that the visions sparked inner change even at the end of life. “It’s the most remarkable of our studies,” Kerr told me. “It highlights the paradox of dying, that while there is physical deterioration, they are growing and finding meaning. It highlights what patients are telling us, that they are being put back together.”

A photo illustration of two silhouettes: one person and one dog.
In the many conversations Kerr and I have had over the past year, the contradiction between medicine’s demand for evidence and the ineffable quality of his patients’ experiences came up repeatedly. He was first struck by this tension about a year before the publication of his first study, during a visit with a World War II veteran named John who was tormented throughout his life by nightmares that took him back to the beaches of Normandy on D-Day. John had been part of a rescue mission to bring wounded soldiers to England by ship and leave those too far gone to die. The nightmares continued through his dying days, until he dreamed of being discharged from the Army. In a second dream, a fallen soldier appeared to John to tell him that his comrades would soon come to “get” him. The nightmares ended after that.

Kerr has been nagged ever since by the inadequacy of science, and of language, to fully capture the mysteries of the mind. “We were so caught up in trying to quantify and give structure to something so deeply spiritual, and really, we were just bystanders, witnesses to this,” he says. “It feels a little small to be filling in forms when you’re looking at a 90-something-year-old veteran who is back in time 70 years having an experience you can’t even understand.” When Kerr talks about his research at conferences, nurses tend to nod their heads in approval; doctors roll their eyes in disbelief. He finds that skeptics often understand the research best when they watch taped interviews with patients.

What’s striking about this footage, which dates back to Kerr’s early work in 2008, is not so much the content of the visions but rather the patients’ demeanor. “There’s an absence of fear,” Kerr says. A teenage girl’s face lights up as she describes a dream in which she and her deceased aunt were in a castle playing with Barbie dolls. A man dying of cancer talks about his wife, who died several years earlier and who comes to him in his dreams, always in blue. She waves. She smiles. That’s it. But in the moment, he seems to be transported to another time or place.

Kerr has often observed that in the very end, dying people lose interest in the activities that preoccupied them in life and turn toward those they love. As to why, Kerr can only speculate. In his 2020 book, “Death Is but a Dream,” he concludes that the love his patients find in dying often brings them to a place that some call enlightenment and others call God. “Time seems to vanish,” he told me. “The people who loved you well, secured you and contributed to who you are are still accessible at a spiritual and psychological level.”

That was the case with Connor O’Neil, who died at the age of 10 in 2022 and whose parents Kerr and I visited in their home. They told us that just two days before his death, their son called out the name of a family friend who, without the boy’s knowledge, had just died. “Do you know where you are?” Connor’s mother asked. “Heaven,” the boy replied. Connor had barely spoken in days or moved without help, but in that moment, he sat up under his own strength and threw his arms around her neck. “Mommy, I love you,” he said.

Kerr’s research finds that such moments, which transcend the often-painful physical decline in the last days of life, help parents like the O’Neils and other relatives grieve even unfathomable loss. “I don’t know where I would be without that closure, or that gift that was given to us,” Connor’s father told us. “It’s hard enough with it.” As Kerr explains, “It’s the difference between being wounded and soothed.”

In June, I visited the adult daughter of a patient who died at home just days earlier. We sat in her mother’s living room, looking out on the patio and bird feeders that had given the mother so much joy. Three days before her mother’s death, the daughter was straightening up the room when her mother began to speak more lucidly than she had in days. The daughter crawled into her mother’s bed, held her hand and listened. Her mother first spoke to the daughter’s father, whom she could see in the far corner of the room, handsome as ever. She then started speaking with her second husband, visible only to her, yet real enough for the daughter to ask whether he was smoking his pipe. “Can’t you smell it?” her mother replied. Even in the retelling, the moment felt sacred. “I will never, ever forget it,” the daughter told me. “It was so beautiful.”

I also met one of Banas’s patients, Peggy Haloski, who had enrolled in hospice for home care services just days earlier, after doctors at the cancer hospital in Buffalo found blood clots throughout her body, a sign that the yearlong treatment had stopped working. It was time for her husband, Stephen, to keep her comfortable at home, with their two greyhounds.

Stephen led Banas and me to the family room, where Peggy lay on the couch. Banas knelt on the floor, checked her patient’s catheter, reduced her prescriptions so there were fewer pills for her to swallow every day and ordered a numbing cream for pain in her tailbone. She also asked about her visions.

The nurse on call that weekend witnessed Peggy speaking with her dead mother.

“She was standing over here,” Peggy told Banas, gesturing toward the corner of the room.

“Was that the only time you saw her?” Banas asked.

“So far.”

“Do you think you’ll be seeing her more?”

“I will. I will, considering what’s going on.”

Peggy sank deeper into the couch and closed her eyes, recounting another visit from the dead, this time by the first greyhound she and Stephen adopted. “I’m at peace with everybody. I’m happy,” she said. “It’s not time yet. I know it’s not time, but it’s coming.”

When my mother, Chloe Zerwick, was dying in 2018, I had never heard of end-of-life visions. I was acting on intuition when her caregivers started telling me about what we were then calling hallucinations. Mom was 95 and living in her Hudson Valley home under hospice care, with lung disease and congestive heart failure, barely able to leave her bed. The hospice doctor prescribed an opioid for pain and put her on antipsychotic and anti-anxiety medicines to tame the so-called hallucinations he worried were preventing her from sleeping. It is possible that some of these medications caused Mom’s visions, but as Kerr has explained, drug-induced hallucinations do not rule out naturally occurring visions. They can coexist.

In my mother’s case, I inherently understood that her imaginary life was something to honor. I knew what medicine-induced hallucinations looked and felt like. About 10 years before her death, Mom fell and injured her spine. Doctors in the local hospital put her on an opioid to control the pain, which left her acting like a different person. There were spiders crawling on the hospital wall, she said. She mistook her roommate’s bed for a train platform. Worse, she denied that I loved her or ever did. Once we took her off the medicine, the hallucinations vanished.

The visions she was having at the end of her life were entirely different; they were connected to the long life she had led and brought a deep sense of comfort and delight. “You know, for the first time in my life I have no worries,” she told me. I remember feeling a weight lift. After more than a decade of failing health, she seemed to have found a sense of peace.

The day before her death, as her breathing became more labored, Mom made an announcement: “I have a new leader,” she said.

“Who is that?” I asked.

“Mark. He’s going to take me to the other side.”

She was speaking of my husband, alive and well back home in North Carolina.

“That’s great, Mom, except that I need him here with me,” I replied. “Do you think he can do both?”

“Oh, yes. He’s very capable.”

That evening, Mom was struggling again to breathe. “I’m thinking of the next world,” she said, and of my husband, who would lead her there. The caregiver on duty for the night and I sat at her bedside as Mom’s oxygen level fell from 68 to 63 to 52 and kept dropping until she died the next morning. My mother was not a brave person in the traditional sense of the word. She was afraid of snakes, the subway platform and any hint of pain. But she faced her death, confident that a man who loves her daughter would guide her to whatever lay ahead.

“Do you think it will happen to you?” she asked me at one point about her dreaming life.

“Maybe it’s genetic,” I replied, not knowing, as I do now, that these experiences are part of what may await us all.

Complete Article HERE!

Why I imagined my husband’s death

— What if fiction can alter the real world?

By

In my new novel, A Book of Days, a husband is dying slowly. While I was writing it, my own husband died suddenly, with no warning. He died in his sleep, I was told. His children and I hope that is true. He was 400 miles away, and on his own when it happened. The thought of his loneliness, if he was conscious and aware of what was coming, is unbearable, so we do not think of it. Or we try not to. We do know that he was in bed and his window was wide open; before he could hear nothing more, he would have heard the sea breaking on the rocky shore just below the cottage.

Ever since, I’ve been thinking about the lived experience of death. I don’t mean the first-hand testimonies of people who have actually died. If Lazarus told his sisters what it was like to be dead, they did not record it. If Jesus ever described the loneliness of the tomb, his words have been forgotten. No, I mean death as experienced by the living, the survivors.

The experience of death was once far more widely shared. Two hundred years ago, around 15% of babies in Britain died before their first birthdays. “Death borders upon our birth and our cradle stands in the grave”, said a 17th-century bishop of Exeter. Childbirth was dangerous for mothers too. And back then, most people in this country died in their own beds at home, with their families watching. If they did not, if they died on Flanders Fields for instance, their deaths were still not private in the main. But now many people reach adulthood without ever seeing a corpse.

I have seen several corpses, but I did not see the dead body of my husband. For complicated reasons to do with autopsies, transport and distance, neither I nor our children saw him until he was in a sealed coffin in the back of a hearse. I put my hand on his coffin as we filed past it on our way out of the crematorium, but I wish now that I had asked for it to be unsealed. Or that we had gone to the mortuary where he was. If you don’t see that the one you loved is really dead, how can you believe it?

My main feelings when he died were disbelief and a stony sort of shock that left me dry-eyed and clear-headed. And then there were weeks and weeks of paperwork and practicalities that left no space at all to think about my unfinished novel. There was only the haunting fear that by writing a death I had brought a real one into existence. My rational self knew that was not true. Fictions are not premonitions, any more than dreams are. But still.

“There was only the haunting fear that by writing a death I had brought a real one into existence.”

Even when life returned to something close to normal, I could not write the novel. For a while, I thought about writing a memoir instead, a painfully truthful one, about my husband, my grief and anger, and how complicated mourning is. Truth seemed somehow more relevant than fiction; I kept remembering something novelist Rachel Cusk said in an interview: “Once you have suffered sufficiently, the idea of making up John and Jane and having them do things together seems utterly ridiculous.” I made a start on the unvarnished work I had in mind and then abandoned it almost at once. I knew then that I had had more than enough of me.

If I had written and published that memoir, I would have been asking you, the reader, to sympathise with me. Even, perhaps, to identify with my lived experience of grief. Why should you want to do that? My experience is particular but not in any way unique. If, on the other hand, I could write imaginatively enough to transcend the limits of that experience, to widen it, to bring to it the resonances of other lives, other ways of seeing — well, that I felt would be worth doing. I, as the author, would be opening windows for the reader, not beckoning them to follow me into a shuttered room.

Autofiction — fictionalised autobiography that dispenses with the traditional elements of the novel such as character and plot — is arguably the prevailing literary mode of our time. It suits the general demand for self-revelation in life as well as art: in print, on screens, in public, people share the most intimate of details and bare their souls — or seem to. For years, aspiring writers of fiction have been told to “write what you know”, to stick to their own experience and their own boundaries, and by writing their own lives in thin disguise they are demonstrating their obedience to the rule. This is in many ways a good thing. Care must be taken not to trespass clumsily on territories of gender, racial identity, or sexual orientation. But there’s a difference between unacceptable cultural appropriation and creative imagination. That difference can be described as empathy.

However carefully curated, whatever balance it strikes between “truth” and “story”, auto-fiction requires ego. It says: look at me, even though what you see may actually be a mask. And it implicitly assumes a degree of mutual recognition between writer and reader. It’s a mirror, not a clear window. This can often be immensely valuable. But how, then, can a reader step outside their own personal experience, to feel as Keats felt when he first read Homer: “like some watcher of the skies / When a new planet swims into his ken”, breathless with anticipation like Cortez’s men, “silent, upon a peak in Darien”? How, indeed, unless writers can still write of lives beyond their own known and confined realities?

Great writers don’t need lived experience to convey emotion. The psychologist Steven Pinker described an experiment in which people listened to an interview with a heroin addict, who was either a real person or an actor. When the listeners were asked to take the addict’s point of view, they became more sympathetic to addicts in general, even when they knew the interviewee was acting. In other words, they did not need to believe the “addict” was sharing a lived experience in order to empathise. We can see this in William Golding’s astonishing novel, The Inheritors, which takes us into the world of the last Neanderthals and shows us how it feels to be on the wrong side of the cusp of change: disempowered, under threat and fearful. He achieved this masterpiece through an empathetic leap across millennia that owes everything to his brilliance as a writer and his understanding of unchanging human nature, but little to his own experience of life in 20th-century England.

As T.S. Eliot said: “What every poet starts from is his own emotions [but then transmutes] his personal and private agonies into something rich and strange, something universal and impersonal.” To me, that’s a counsel of perfection, the highest of aspirations. My husband’s death caused me great grief, but when eventually I could write that grief upon the page, through voices that were those of imagined people who lived centuries ago, I hope I turned it into something shared, something that could strike chords in hearts other than my own.

Complete Article HERE!

Senior suicide

— The silent generation speaking up on a quiet killer

Graham and Bruce from the Ettalong men’s shed in NSW.

Over-85s have become the Australians most susceptible to suicide and a general lack of support is threatening to make the problem worse

By

The age group most at risk of suicide may not be the one you expect.

The highest rate of suicide in Australia, for both men and women, is among people over 85, at 32.7 deaths per 100,000 for men and 10.6 deaths for women, respectively.

The global picture is similar. People over the age of 70 kill themselves at nearly three times the rate of the general population. Suicide attempts are also more lethal among older people, with US data showing that about one in four suicide attempts of older people result in death, compared with one in 25 among the general population.

But even these numbers are likely to be underestimates, says Prof Diego De Leo, emeritus professor of psychiatry at Griffith University.

Unless the death of an older person is very clearly a suicide, it is not likely to be investigated, he says, and deaths relating to misuse of medication or even falls that may have been deliberate are often assumed to be the result of senility or frailty.

“It’s widely reported in literature that there’s much more interest in scrutinising the causes of death of a young body than of an old man,” he says.

Helen Bird, 73, from the inner west in Sydney, believes her grandmother’s death fits in this category.

In 1985, Bird got a call to say that her grandmother Olive, 82, had been found in her nursing home room in Hobart with a serious head injury after falling. She died in hospital shortly after. Bird is convinced her grandmother’s death was suicide, knowing that her grandmother had been depressed and had been stockpiling her medication.

Trained nurse Helen Bird
Trained nurse Helen Bird believes her grandmother suicided in a nursing home, although the death was not recorded as such.

“Nothing stacked up,” she said. “I’m a nurse. But nobody ever asked a question. It was a fall, no one questioned it. It was something that really nobody wanted to hear about.

“It’s something that’s always been with me, with great sorrow really,” Bird says. “She felt, I suspect, there was just nothing more to live for, and that’s really, really sad.”

De Leo says there are very different assumptions around suicide for younger and older people. While suicide by a young person is treated as a tragedy and a mystery, an older person’s suicide is often seen as a rational decision.

“It’s this assumption: ‘he was making a balance between pros and cons in life and he discovered the cons were more than pros and he decided then to exit life’, it’s a rational balance,” he says.

Dr Rod McKay, a psychiatrist with a clinical practice focusing on older people, says it is sometimes assumed that someone dying through suicide later in life has less impact on people.

“Someone dying through suicide later in life does have a different impact on those who know them, but it’s not lesser,” he says.

Both McKay and De Leo are keen to draw a distinction between suicide among older people who are depressed and voluntary assisted dying (VAD), which is now legal in every state in Australia under tight restrictions.

“If someone comes to me and says ‘I want to die because I’m depressed and I see no solution to my depression’, well, as a physician I have to do my maximum best to intervene and try to improve the depression of this person, and I can,” says De Leo. “But [if someone comes with] chronic pain, chronic suffering, no hopes for improvement and inevitability of a progression of the suffering … then I feel different.”

McKay says well-meaning attempts to respect individual choices in regard to VAD, may have meant that physicians have not been proactive in referring older people for treatment of depression.

“That debate and the sensitivities everyone is feeling about trying to act respectfully, risks not identifying or investigating depression or reversible factors to the degree that we might,” he says.

A lifeline for men

Men die by suicide at much higher rates than women across all age groups. Among older men, loss of purpose and identity after retirement, weaker connections to children and grandchildren and to social networks can all be factors.

“We’ve never had anyone here who has taken their own life, or entertained that, that I know of,” says Bruce McLauchlan, president of the Peninsula Community Men’s Shed in Ettalong, an hour and a half’s drive north of Sydney, knocking on a wooden work bench. “Maybe, we hope, it’s the contribution of our shed that helps.

“We look for these things: a person who was lively and talkative goes quiet, then we say: ‘Mate, everything OK with you? Anything we can help with?’. Because we are a family,” McLauchlan says.

The Ettalong group, part of the global men’s shed movement, opens its metalworking and woodworking sheds three mornings a week. On a rainy Thursday, the men are just finishing their monthly barbecue lunch, which is sponsored by a local funeral home.

“It’s publicity for them,” laughs Graham Checkley, 84, a retired Baptist minister who is the group’s welfare officer. “We go to a lot of wakes.”

The group is a lifeline for a lot of men, especially after retirement or bereavement. McLauchlan started coming 12 years ago after his wife died. “The men’s shed helps me manage my grief. Otherwise, I’d be sitting at home watching TV all day.”

Garrick Hooper, 73, started coming three years ago after he retired as a taxi driver, and is still coming, “much to my amazement”.

“I always knew about it and I thought: ‘I’ll be avoiding that like the plague, I’m meaningfully employed.’ And then there comes a time that you’re not and you become officially elderly,” Hooper says. “When you retire, you’ve got to redefine yourself, and that’s just how it is.”

Having a laugh together is a big part of the Ettalong Men’s Shed.
Having a laugh together is a big part of the Ettalong men’s shed.

McKay says this sort of social intervention is incredibly important, and older people have far more resilience than they are often given credit for.

“The vast majority of older people don’t feel as old as other people view them as,” he says. “We look at older people, including older people with lots of problems and say ‘I couldn’t cope with that’. Whereas most older people cope well … so we project that on to them.”

Studies show psychological wellbeing actually improves into older age, though depression goes up again in the over-85 age group.

When that happens, McKay says, social interventions are not enough.

“Older people have extremely low access to psychological treatments, the lowest of any age group,” he says.

This can be as a result of unconscious ageism among medical professionals and a sort of therapeutic nihilism that sees depression as an inevitable part of old age and not something that can be treated.

When older people do receive treatment for depression, it can make a huge difference.

“We know that when you look at things clinically, if there is mental illness there, the likelihood of response to treatment is similar to younger people,” McKay says. “There are a lot of social factors that can be addressed, sometimes there are simple medical factors that can be addressed that can make a huge difference in whether someone sees suicide as an option or not.

“It continues to amaze me sometimes when I meet people and see how poor their quality of life is and then with a good review from a geriatrician or a GP who has the time to do it – and it does take time – just the improvement they can have in their quality of life.”

Complete Article HERE!

‘Duo euthanasia’

— In the Netherlands, a famous couple chooses to die together

Former Dutch prime minister Dries van Agt and his wife, Eugenie, in Den Bosch, the Netherlands, in June 1983.

By

The vow is “til death do us part.” But for former Dutch prime minister Dries van Agt and his wife, Eugenie, the aim was to leave this life the same way they had spent the past seven decades — together.

The couple, both 93, died “hand in hand” earlier this month, according to a statement from the Rights Forum, a pro-Palestinian organization that Dries van Agt created. They chose to die by what is known as “duo euthanasia” — a growing trend in the Netherlands, where a small number of couples have been granted their wish to die in unison in recent years, usually by a lethal dose of a drug.

A longtime politician who had conservative roots but campaigned for numerous liberal causes, van Agt served as prime minister of the Netherlands from 1977 to 1982. He later became the European Union’s ambassador to Japan and the United States

Photos of the couple from their decades-long careers as public figures often show them walking in step: waving to crowds through a car window, voting together at an election site and giving each other a smooch at a public event.

The van Agts’ health had declined in recent years, Dutch public broadcaster NOS reported. The former prime minister never fully recovered after suffering a brain hemorrhage in 2019, which happened while he was delivering a speech at a commemoration event for Palestinians. Eugenie’s health issues were largely kept private.

“I feel like it’s kind of beautiful, honestly, that you’ve lived your life together, you both happen to be gravely ill without a chance of getting better, you’re ready to go, and you would like to go together,” said Maria Carpiac, director of the gerontology program at California State University at Long Beach.

When it comes to the right to choose one’s own death, the Netherlands is “kind of the model” for any U.S. legislation on the topic, she said.

At least 29 couples — or 58 people — died together via duo euthanasia in 2022, the most recent year of data from the country’s Regional Euthanasia Review Committees. That’s more than double the 13 couples who did so in 2020, when the committee first started looking at partners specifically, but it still represents only a small fraction of the 8,720 people who legally died by euthanasia or assisted suicide in the Netherlands that year.

“It is likely that this will happen more and more often,” said Rob Edens, press officer for NVVE, a Dutch organization focused on research, lobbying and education about assisted suicide and euthanasia in the Netherlands. “We still see a reluctance among doctors to provide euthanasia based on an accumulation of age-related conditions. But it is permitted” in the country’s legal guidelines, he said in an email.

Assisted suicide is when a person self-administers a lethal dose while a physician is present, while euthanasia is when a medical professional administers the dose. Both are legal in the Netherlands when specific criteria are met. (Some groups prefer the term “medical aid in dying,” or MAID, due to religious and social stigma around suicide.)

Euthanasia is illegal in the United States, but assisted suicide is allowed in D.C. and at least 10 states: Oregon, Washington, Montana, Vermont, California, Colorado, Hawaii, New Jersey, Maine and New Mexico. Eligibility requirements tend to be strict across the country, Carpiac said, but there are differences between jurisdictions.

The Netherlands, a country of almost 18 million people, has allowed assisted suicide and euthanasia since 2002. It requires that individuals willingly request the termination of their life in a manner that is “well-considered,” with a sign-off from a doctor that they are experiencing “unbearable suffering with no prospect of improvement.”

Another physician then has to agree that the person qualifies, and doctors can choose whether they are involved in the procedure. After every death, doctors are required to notify a regional review committee, which examines whether each case was handled lawfully. Couples who seek duo euthanasia are required to apply and undergo the review process individually, with separate doctors.

“An accumulation of age-related complaints can lead to unbearable and hopeless suffering,” Edens said, explaining the Dutch guidelines. “The expectation is that if doctors are increasingly willing to provide euthanasia when there is an accumulation of old-age complaints, the number of duo euthanasia [cases] will increase.”

Research suggests that older Americans are at a higher risk of dying after losing a spouse, particularly in the first few months after their death. While the cause of this phenomenon is unclear, studies have found that grieving partners have higher rates of inflammation and are at increased risk of heart attack and stroke, often due to stress-induced changes in blood pressure, heart rate and blood clotting.

“The first thing that came to my mind was the widowhood effect,” Carpiac said, referring to the van Agts’ choice to die by duo euthanasia. “I have a grandmother who is 96, and she’s like, ‘I’m not going anywhere!’ But if I had a partner and they were my person, and we were both kind of at the end of our lives, would it be worth it if he were to go without me? Would I die of what I considered to be a broken heart? I would want to have a choice.”

Complete Article HERE!

End-Of-Life

— The One Decision AI Cannot Predict

We often talk about personalized medicine; we hardly ever talk about personalized death.

By Dr. Tal Patalon, MD, LLB, MBA

End-of-life decisions are some of the most intricate and feared resolutions, by both patients and healthcare practitioners. Although multiple sources indicate that people would rather die at home, in developed countries they often end their lives at hospitals, and many times, in acute care settings. A variety of reasons have been suggested to account for this gap, among them the under-utilization of hospice facilities, partially due to delayed referrals. Healthcare professionals do not always initiate conversations about end-of-life, perhaps concerned about causing distress, intervening with patients’ autonomy, or lacking the education and skills of how to discuss these matters.

We associate multiple fears with dying. In my practice as a physician, working in palliative care for years, I have encountered three main fears: fear of pain, fear of separation and fear of the unknown. Yet, living wills, or advanced directives, which could be considered as taking control of the process to some extent, are generally uncommon or insufficiently detailed, leaving family members with an incredibly difficult choice.

Apart from the considerable toll they face, research has demonstrated that next-of-kin or surrogate decision makers can be inaccurate in their prediction of the dying patient’s preferences, possibly as these decisions personally affect them and engage with their own belief systems, and their role as children or parents (the importance of the latter demonstrated in a study from Ann Arbor).

Can we possibly spare these decisions from family members or treating physicians by outsourcing them to computerized systems? And if we can, should we?

AI For End-Of-Life Decisions

Discussions about a “patient preference predictor” are not new, however, they have been recently gaining traction in the medical community (like these two excellent 2023 research papers from Switzerland and Germany), as rapidly evolving AI capabilities are shifting the debate from the hypothetical bioethical sphere into the concrete one. Nonetheless, this is still under development, and end-of-life AI algorithms have not been clinically adopted.

Last year, researchers from Munich and Cambridge published a proof-of-concept study showcasing a machine-learning model that advises on a range of medical moral dilemma: the Medical ETHics ADvisor, or METHAD. The authors stated that they chose a specific moral construct, or set of principles, on which they trained the algorithm. This is important to understand, and though admirable and necessary to have been clearly mentioned in their paper, it does not solve a basic problem with end-of-life “decision support systems”: which set of values should such algorithms be based on?

When training an algorithm, data scientists usually need a “ground truth” to base their algorithm on, often an objective unequivocal metric. Let us consider an algorithm that diagnoses skin cancer from an image of a lesion; the “correct” answer is either benign or malignant – in other words, defined variables we can train the algorithm on. However, with end-of-life decisions, such as do-not-attempt-resuscitation (as pointedly exemplified in the New England Journal of Medicine), what is the objective truth against which we train or measure the performance of the algorithm?

A possible answer to that would be to exclude moral judgement of any kind and simply attempt to predict the patient’s own wishes; a personalized algorithm. Easier said than done. Predictive algorithms need data to base their prediction on, and in medicine, AI models are often trained on a large comprehensive dataset with relevant fields of information. The problem is that we don’t know what is relevant. Presumably, apart from one’s medical record, paramedical data, such as demographics, socioeconomic status, religious affiliation or spiritual practice, could all be essential information to a patient’s end-of-life preferences. However, such detailed datasets are virtually non-existent. Nonetheless, recent developments of large language models (such as ChatGPT) are allowing us to examine data we were previously unable to process.

If using retrospective data is not good enough, could we train end-of-life algorithms hypothetically? Imagine we question thousands of people on imaginary scenarios. Could we trust that their answers represent their true wishes? It can be reasonably argued that none of us can predict how we might react in real-life situations, rendering this solution unreliable.

Other challenges exist as well. If we do decide to trust an end-of-life algorithm, what would be the minimal threshold of accuracy we would accept? Whichever the benchmark, we will have to openly present this to patients and physicians. It is difficult to imagine facing a family at such a trying moment and saying “your loved one is in critical condition, and a decision has to be made. An algorithm predicts that your mother/son/wife would have chosen to…, but bear in mind, the algorithm is only right in 87% of the time.” Does this really help, or does it create more difficulty, especially if the recommendation is against the family’s wishes, or is delivered to people who are not tech savvy and will struggle to grasp the concept of algorithm bias or inaccuracies.

This is even more pronounced when we consider the “black box” or non-explainable characteristic of many machine learning algorithms, leaving us unable to question the model and what it bases its recommendation on. Explainability, though discussed in the wider context of AI, is particularly relevant in ethical questions, where reasoning can help us become resigned.

Few of us are ever ready to make an end-of-life decision, though it is the only certain and predictable event at any given time. The more we own up to our decisions now, the less dependent we will be on AI to fill in the gap. Claiming our personal choice means we will never need a personalized algorithm.

Complete Article HERE!

Vatican Museums Open Ancient Roman Necropolis To The Public For The First Time

— A Fascinating Addition to the Vatican City Museums

The Vatican Museums, located within the awe-inspiring Vatican City, are renowned worldwide for their vast collections of art and historical artifacts. Serving as a beacon for art enthusiasts and history buffs alike, these museums offer a unique glimpse into the grandeur of the Catholic Church and its rich cultural heritage. However, a recent development has taken place that has further enhanced the allure of the Vatican City Museums. The Vatican Museums have now opened an ancient Roman necropolis to the public for the first time. This exciting addition allows visitors to journey even further back in time, exploring the intriguing burial practices and customs of ancient Romans. Let’s delve deeper into this newfound treasure and dive into the wonders of the Vatican Museums.

Delving into the Vatican City Museums: A Haven of Art and History

The Vatican City Museums have long been regarded as a treasure trove of masterpieces. With an extensive collection spanning various epochs and artistic styles, these museums grant a mesmerizing experience of the pinnacle of human creativity. Every year, millions of visitors flock to marvel at the Sistine Chapel, the monumental Saint Peter’s Basilica, and the breathtaking Raphael Rooms. However, until recently, the Vatican Museums had yet to unveil an untapped gem within their vast complex: an ancient Roman necropolis.

Journalists visit an ancient necropolis along the via triumphalis, an archaeological area containing a Roman burial ground during the presentation to the press of the new entrance to the site at the Vatican, Tuesday, Nov. 14, 2023. (AP Photo/Gregorio Borgia)

Unearthing the Past: The Roman Necropolis of the Vatican

Located below the Vatican City, the Roman necropolis offers visitors a unique opportunity to immerse themselves in ancient history. The term“necropolis” derives from ancient Greek, meaning“city of the dead,” and refers to the burial grounds used by ancient civilizations. These necropolises hold immense historical and archaeological value, shedding light on aspects of daily life, beliefs, and burial practices of the people who lived during those times. The Roman necropolis beneath the Vatican City encapsulates this sentiment and offers an intriguing insight into the lives of ancient Romans.

From Tombstone to Time Machine: Exploring the Roman Necropolis

As visitors embark on their journey through the Roman necropolis, they will be transported back in time through a series of well-preserved burial chambers and tombs. The necropolis spans several centuries and allows visitors to witness the evolution of burial practices, from simple chambers to elaborate mausoleums adorned with intricate artwork. The subterranean network of tunnels and chambers showcases the diversity of tombs, offering a glimpse into the social structure and beliefs of ancient Roman society.

A mosaic is displayed inside an ancient necropolis along the via triumphalis, an archaeological area containing a Roman burial ground during the presentation to the press of the new entrance to the site at the Vatican, Tuesday, Nov. 14, 2023.

Unveiling the Ancient Art of Funeral Rites

The Roman necropolis is not only a testament to the architectural brilliance of the ancient world; it is a showcase of the artistry and reverence held for the deceased. Visitors will discover beautifully carved sculptures and intricate tomb decorations, depicting scenes from mythology and capturing the essence of the departed individuals’ lives. Elaborate frescoes, mosaics, and inscriptions add depth and texture to the necropolis, unveiling the customs, traditions, and spiritual beliefs associated with funeral rites.

Roman Necropolis: A Portal to the Past

For centuries, the Roman necropolis has remained hidden beneath the Vatican, preserved in remarkable condition. Now, with its doors opened to the public, visitors have the opportunity to traverse an underground time capsule. Walking through the narrow passageways, visitors can ponder the stories of those who lived centuries ago, imagining the lives they led and the legacy they left behind. It is an experience that not only piques curiosity but also fosters a profound understanding of our shared human history.

Preservation Challenges: Balancing Access and Conservation

The decision to open the Roman necropolis to the public was undoubtedly a challenging one. Preservation efforts need to strike a balance between providing public access and ensuring the ongoing conservation of these invaluable ancient artifacts. The Vatican Museums have vigilantly implemented measures to protect the necropolis, including environmental controls, regular maintenance, and visitor limits. This delicate equilibrium ensures that future generations can continue to enjoy and learn from this extraordinary archaeological site.

The Power of Immersive Education: Learning through Exploration

By offering access to the Roman necropolis, the Vatican Museums enrich the educational experience for visitors of all ages. Instead of merely observing artifacts from a distance, visitors can now actively engage with history, fostering a deeper understanding and appreciation for ancient Roman culture. The opportunity to explore these hidden chambers and decipher the stories they hold creates a sense of wonder and ignites a desire for further exploration and learning.

A Glimpse into the Past

The Vatican Museums’ decision to open the ancient Roman necropolis to the public provides a remarkable opportunity to step back in time and immerse oneself in the mysteries of ancient Rome. This newly accessible site adds another layer of fascination to the already captivating Vatican City Museums. As visitors traverse the subterranean corridors and stand before monumental tombs, they can forge a connection with the past, appreciating the richness and complexity of ancient Roman culture. We can only hope that this extraordinary archaeological treasure will continue to be preserved and shared for generations to come, allowing future visitors to be inspired by the wonders of the Roman necropolis.

Complete Article HERE!