Love at the end of life

By Maryse Zeidler

Meaghan Jackson has a surprising amount of insight into death and love for a 36-year-old.

“Working here, it’s changed me,” Jackson said from a wood-panelled room at the North Shore Hospice, where she has worked as a music therapist for four years.

“It’s completely changed the trajectory of my life.”

Meaghan Jackson is a music therapist at the North Shore Hospice. Jackson says working in palliative care has changed her life.

Jackson guides the residents at the hospice through their final days. She helps them write songs for their loved ones, and plays music for them as they take their last breaths.

Jackson has worked in “death and dying” since she was 22. She says her experiences prompted her to have children early in life, and focus on the present, no matter how difficult.

“I practice the art of being present when that present isn’t pleasant,” she said.

Health practitioners like Jackson say their experiences working with dying patients offer insights into love, relationships and how to focus on what matters.

A room at the B.C. Cancer Centre in Vancouver. Health practitioners say patients facing death tend to prioritize their relationships.

Each of the four practitioners interviewed for this story — a doctor, a social worker, a nurse and a music therapist — say dying patients tend to focus their energy and attention on the people they love.

Dr. Pippa Hawley, a palliative care doctor at the B.C. Cancer Centre, says she has seen couples and families reconcile after decades apart. She’s also seen several of her dying patients get married in the palliative care unit, sometimes in their beds.

Hawley says dying patients don’t have time to take loved ones for granted.

“All of that stuff that we bother with on a day-to-day basis just fades into irrelevancy,” she says.

Dying patients face many challenges with their partners, even when they prioritize love.

Melanie McDonald, a social worker who also works in palliative care at the B.C. Cancer Centre, says every couple she helps deals with death differently.

Couples who thrive during difficult moments are often those who can balance sadness with joy and love, she says.

Social worker Melanie McDonald says couples face many challenges when faced with death.

Nurse Jane Webley, who leads Vancouver Coastal Health’s palliative care unit, says the strongest couples are best at honestly communicating their needs, feelings and end-of-life plans.

Webley says patients who find it too difficult to discuss those matters are often the same ones who push loved ones away and face death alone.

“I think that’s a protection mechanism,” she said. “I would say 90 per cent of the time, it’s fear — and that fear is brought about by lack of communication.”

Dr. Hawley says some of her patients are never able to communicate their feelings and needs. Often, she says, that’s been a long-standing issue for them.

“People tend to die as they have lived,” she said.

Talking about death and end-of-life plans is often easier for older couples who are often more in touch with mortality. But Webley says it’s never too soon to have those difficult conversations.

Another challenge couples face when one is dying is learning to give or receive help, health practitioners say.

Social worker McDonald says people who aren’t used to being caregivers, typically men, often struggle when they’re suddenly thrust into that position. But most people learn to take on that role, she says.

Health practitioners say that learning to ask for help can be a steep learning curve for some patients.

Dr. Hawley says patients can face problems as they lose their independence. But she says it’s important for people to let their partners care for them.

“Don’t feel like you’re a burden,” she said. “It’s actually a wonderful gift to be allowed to care for somebody, to show them that you love them.”

All four of the health care practitioners say love at the end of life can take many shapes.

“Love looks differently in different situations,” says social worker McDonald. “Love shows up in the end of life in friendship and in families and pets and faith traditions and all sorts of different ways.”

Complete Article HERE!

How To Grieve When A Loved One Chooses To Die

By Chloe Gray

My great grandma, or Mia, as we knew her, was 100 when she decided she was ready to die. I found this out through a nonchalant conversation with my granny, her daughter, just after Christmas. She was eating a bowl of porridge at the breakfast bar, and said: “Mia wants to go, and that’s legal in Canada.”

Was I shocked? Not really. Although I didn’t actually know that Canada, where she had lived all her life, offered medically assisted dying (MAiD), my family are the type to take things into our own hands.

It’s a weird thing, euthanasia. It’s something you’re taught about in RE lessons at school, debating whether we have a right to ‘play God’. It’s something I agreed with as a faraway idea that I’d never have to consider. Something I thought was good in theory but hadn’t ever put any serious thought into the practice.

When I learned about Mia, I agreed with it still. Everyone I told did too, commenting on how brave her decision was and how amazing it was that she had this ‘opportunity’. They may have been thinking about the procedure itself rather than offering support but that was okay, because this was, overall, A Good Thing.

Meanwhile, with my family, talk swiftly turned to logistics. Timetables detailing who would be where and when were emailed around and the bank split Mia’s estate equally, with cheques ready to be collected by her children on the ride home from the facility. It helped the Canadian side of the family to deal with it Monica Geller-style, working pragmatically through the practical elements of her life.

“We’re more open to things that are predictable,” says Dr Anna Janssen, a psychologist specialising in palliative care. “There’s something safer about it, and that means we can be more flexible in our thinking and more open with ourselves and each other.”

But while they were handling the logistical side, it became very clear that we needed to introduce this flexibility into the emotional side of things, too.

The ‘five stages of grief’ ends with ‘acceptance’. The problem here was that for Mia to go with our blessing, we needed to accept her death before she actually died. That’s an unchartered process; grieving while someone is still alive and well(ish) feels weird. My auntie Penny summarised it perfectly, saying she felt she was going through grief sideways, like a breech birth.

Feeling emotion with a deadline meant we had to sprint through the confusion, the sadness, the relief of it all. If we had been Monica about the logistics, we Chandler-ed around the feelings part somewhat chaotically. But we still all felt weirdly…lucky? “With assisted dying, everyone involved has choice in the death,” explains Judy Tatelbaum, author of The Courage to Grieve. “That makes a great difference. Anticipatory grief is very healthy.”

But I was worried about what the minutes and days after she died would bring, seeing as we had already ‘grieved’. “Maybe the grief afterwards is easier, as some feelings have happened already,” said Dr Janssen. “But eventually there will be something new, because the context has changed, and you can’t feel it until the person has actually died.”

And so the 9th of January came. I asked not to know the exact time she was meeting her doctor, because what do you do in the minutes that someone you love is dying? In the most extreme version of the Schrödinger’s cat experiment, I went into a meeting, curious about whether she’d still be alive when I came out. She wasn’t. But there was an email telling the whole story, including how she had greeted the doctor by asking if he was the nice man who was going to help her.

Yes, my experience introduced a new closeness to my family. But it highlighted a flaw in the current MAiD plan. The message from the guidelines, the ethical debates and the psychologists I’ve spoken to is that assisted dying should be about having autonomy. It should make it easier, because you plan and prepare for the place, time, aftermath and even the feelings. But MAiD is such new territory that there are the same unknowns as with ‘regular’ dying.

Up until now, humans have only ever died after suffering through old age or illness or suddenly and shockingly in an accident. Those five stages of grief have been based on these same experiences over thousands of years. Now, suddenly, we’ve introduced a model where death can be scheduled into our diaries, and we can’t just apply the same rules. There are no history or self-help books to teach us how to navigate a brand-new type of grief that brings up a totally different, sporadic, rushed and uncertain feeling.

While there are articles and research papers discussing ethical, religious and legal boundaries, all the conversations have forgotten the people, families and feelings. And maybe that’s because, as Dr Janssen pointed out to me, it’s easier to discuss facts and figures than it is to discuss emotions.

For my family, MAiD was the first time we all properly discussed dying. Perhaps this is the taboo-breaking policy the world needs? You can’t send out a ‘save the date’ without telling people what for, after all. But to stop the turbulence, there’s still a grief taboo that needs to be broken. “We need to talk about the psychology of death and grief, but also the psychology of living. We talked about the death, but not about how we’re then meant to live well,” said Penny.

For families going through MAiD this year, in five years, or further in the future, when it could be a global policy, the system will benefit if we open up. “At the moment we don’t talk about it enough to know whether that [five stages] model requires more thought,” agrees Dr Janssen. “In my academic brain, I’m thinking we need to ask what MAiD means for people, but really, we’ll simply hear more if we take the time.”

My granny has since told me not to be shocked if she asks for MAiD. Is that a conversation she would have had with me if it wasn’t for Mia taking the plunge? Probably not. And while I haven’t yet applied my newfound skill for discussing death with anyone else, I’ll no longer hold back – especially when talking about my own.

Complete Article HERE!

For this Hong Kong undertaker, every working day is a matter of life and death

Ogden Chan puts his best into making sure bereaved families are taken care of but admits being detached is a necessary part of the job

By Stephanie Tsui

January was a busy month for undertaker Ogden Chan Yan. “It’s peak season for us because more people are dying due to the fickle weather, and many families don’t want to wait until after the Lunar New Year to bury their dead,” the 36-year-old says.

Rows of cardboard boxes containing the ashes of his clients’ loved ones line the shelves of Chan’s shop in Hung Hom. His clients have left the ashes for safekeeping until their deceased are assigned columbarium niches. Chan reckons there are almost 200 of these boxes.

“It’s the typical Hongkonger’s fate: the living can’t afford homes, and the dead can’t find final resting places.”

It has been seven years since Chan joined the industry as an apprentice. Although he applied for the apprenticeship “out of curiosity”, his interest in the funeral sector began in his early teens.

“I wanted to be a mortuary makeup artist because I was under the impression that people in the funeral business made a decent living because there’s always going to be a demand for the service, and I liked how it was something of a craft.”

But that initial perception was somewhat misguided. Chan says that his business has only recently become profitable. Before, he was barely getting by. He now oversees everything from preparing documents and booking cremation services to planning religious ceremonies. As a nod to his childhood dream, he also acts as a makeup artist for his clients’ loved ones.

“I talk to the corpses when I put makeup on them because I believe that our consciousness remains even after we die.”

After a while, he adds: “That said, I’ve never seen a ghost.”

Chan says he has been fearless all his life, even as a child, when he saw a corpse for the first time lying in a construction site in mainland China. The second time he saw a corpse was before he joined the industry, when he was volunteering for a service for inmates. The corpse was already decomposing.

“What impressed me was not the appearance of the corpse – which looked like a zombie out of a video game – but the smell.”

The smell of decay was something Chan had to get used to as soon as he became an undertaker’s apprentice, as was staying detached from clients and their grief.

“In time, I adopted a somewhat dispassionate view of death. As a service provider, I get satisfaction from organising a successful service. After all, it’s the last ceremony a person ever has on this Earth.”

But when Chan presided over his father’s funeral service five years ago, things got personal.

“While making the arrangements, I kept thinking of the times I’d spent with my father. What helped with my grieving process was the fact that I knew exactly what had to be done after his death.”

Chan says he is happy to see that Hongkongers have become more willing to explore and discuss issues related to death, but believes education about death and dying should start young.

“I’ve seen four or five year-olds bawling at their parents’ funerals. They’re old enough to learn the meaning of life and death.”

At that, Chan offers his take on life: “Don’t waste time. Even if you’re given 80 years to live, it’s still not enough. Do as much as you can while you’re around, so when you’re on your deathbed looking back on your life, you can think about all the marvellous things you’ve done.”

So, what is on Chan’s bucket list?

“I want to get a bachelor’s degree. And, like every other Hongkonger, I want to be able to afford my own home.”

Complete Article HERE!

How to die the way you want

Tackling the tough questions over a cup of tea or coffee

By

We’re all dying, every one of us.

But we learn early on that despite the fact our lives are universally finite, most people don’t want to talk about it.

We’ll talk sex, we’ll talk drugs, we’ll even talk money—but not death.

That could be changing with the proliferation of so-called Death Cafes, informal get-togethers in cities across America, Europe and Asia, where people eat a little something, drink some coffee maybe and talk about, well, the inevitable.

The mission is to revamp typically depressing and urgent end-of-life discussions to more leisurely “Everything-I-Wanted-To-Know-About-Death-But-Was-Afraid-To-Ask.”

The conversation ranges, and depends on the group of people who’ve gathered: anything from how much a funeral costs to the details of a “green” funeral (think: corpse as compost) to tips on how to talk to your family members about your own funeral.

There’s a range of people who attend, too, from someone who had a death in the family and wants to be better prepared next time, to health care providers who want a different perspective on dealing with death. They range in age from 20-somethings to 90-somethings.

The object: to turn death from a feared end to something that is part of life.

“Death Cafés change the way you live in the most profound and wonderful way,” says Kim Mooney, 67, who runs monthly meetings in Longmont, Colorado.

Mooney even held a few events in a mortuary. “I like to say it’s the only time you will walk in and walk out of one, so you might as well take advantage of it.”

Death café hosts tend to have a sense of humor.

Death on twitter

If you want to confirm the popularity of the death positive movement, just go on social media. There’s The Death Café Facebook group, which lists times and dates of meeting and has more than 50,000 likes and followers. 

Or you could follow Death Café on Twitter

Advocates say the meetings allow people a low-pressure way to express fears about the Great Unknown; to chat about the way other cultures handle death; and to share practical information, such as learning the nuts and bolts of filling out end-of-life forms.

Talking with strangers, hosts say, is often an easier way to broach the topic before launching a conversation about death with loved ones.

Lizzy Miles is a hospice social worker who hosted America’s first café in 2012 in Westerville, Ohio. She baked cookies in the shape of tombstones with grey icing and “Death Café” where the epitaph normally goes.

She is one of more than a 100 Death Café hosts in this country. She’s still hosting—and still making treats—for nearly a dozen people who show up each month.

Yes, these are the cookies Lizzy makes for her Death Café guests in Ohio.

“No one ever comes to a Death Café already uncomfortable talking about death,” she says. “If you are, you’re not going to come. We have a lot of sandwich generation people, who are taking care of their parents.”

Miles is so committed she even traveled to a Death Café in Hong Kong—“on my own dime!”—to see what it was like. 

“It was amazing, people were speaking English and Mandarin and Cantonese,” she says. “And I thought ‘Oh my gosh, all these different languages. This is pretty cool but almost exactly the same.’” 

Dos and don’ts

Anyone can be a host, but there are guidelines. The Death Café website has a set of guidelines and Miles herself was a co-author on an article that included a list of dos and don’ts in the Omega Journal of Death and Dying: 

Do: Allow a space for folks to share their ideas respectfully and openly. 

Do: Offer the opportunity for everyone to speak but allow those who want to remain silent to do so. 

Don’t: Charge an admission fee. 

Don’t: Sell death-related products. 

Don’t: Turn the group into grief support. 

Miles and others believe that confronting our mortality will prompt us to the make the sorts of life changes that some folks do only when confronted with a fatal disease. Why wait? 

Shellie Balogh, a 61-year-old hospice nurse attended one of Miles’ cafés in Ohio.

 “It wasn’t what I expected; it was more upbeat,” she says. “It’s a fun thing to do if I have a free Saturday. You go and meet people you may never see again and just have this conversation, opening up this forbidden area of discussion.” 

A midwife for dying

Suzanne O’Brien hosts a New York City group that meets at a public library on the Upper West side. She’s a nurse turned death doula.

Death doulas—part of this burgeoning “death-positive” movement—provide the same sort of bedside care, comfort and companionship that birth doulas offer to pregnant women but at the other end of the life cycle. 

O’Brien said monthly conversations tend to fit into five buckets, sometimes all five covered in one 90-minute session: 

The physical: How do I make sure I’m comfortable during my dying hours. What do I want to happen to my body? 

The financial: What forms do I need to fill out? Or how much money do I want to spend on a funeral versus, say, end-of-life care? 

The emotional: How do we deal with potential regrets or forgiveness? 

The mental: Reasoning and acceptance  

The spiritual: How do beliefs about death inform the way we live.  

One woman wanted to know how to donate her body to a medical school anatomy class. She also wanted to make sure her family would not be given the leftovers when the students are done picking her apart, something she had heard can happen. 

She told the group: “I’d rather just be flushed.” 

Banishing the secrecy

The idea of a group of a random community members chatting about death over refreshments was the brainchild of Swiss sociologist Bernard Crettaz. He launched a “Café Mortel” in 2004 in the lakeside town of Neuchâtel, Switzerland. A dozen mortal members attended. 

The point, as he once told a reporter for the Independent, a British newspaper, was to remove death talk from its “tyrannical secrecy.” 

The first cafe outside of Switzerland was held by John Underwood,  who hosted in his London basement in 2011. He’s given credit for helping the movement go global; he died last year, at the age of 44, from undiagnosed leukemia.

Today, there are death-with-food meetings in about 55 countries—including the U.K., Italy, Hong Kong, Finland, the Netherlands and New Zealand.

Becoming a regular

Those who are regulars say that while the subject matter is death, the meetings are not sad. Hosts emphasize that they are not grief support groups, more death-curious groups.

Jane Geller, a retired schoolteacher in New York City attends the Upper West Side meeting nearly every month.

“It’s a misnomer to think it’s depressing,” she said. “Death Cafés are really about life.” 

Shatzi Weisberger, an 88-year-old retired nurse from New York City is a regular, too. 

 “I was always especially interested in how we come into this world and how we leave it. When I got into my eighties, I got personally interested for my own edification.” 

Last fall, she hosted her own “FUN-eral” (pronounced Funn-eral) in the common room of her apartment building. More than 100 attendees came to the event. It sounded like a macrabe-themed birthday but she said it was a death, not a birth, party. And a way to attend her own funeral. 

She said she has planned her own green burial. “I’m going to be wrapped in a shroud and buried in the woods upstate and my body will deteriorate and something will grow.  I don’t know if it will be grass or flowers or a tree so I feel my dying is bringing life into the world. That’s not depressing at all.”

Complete Article HERE!

Research examines living well while dying

by

A UBC professor has determined that people diagnosed with terminal cancer—who have hope, positivity and family support—are able to live well during the advanced stage of the disease.

Carole Robinson, professor emeritus with UBC Okanagan School of Nursing, recently published a paper explaining the process of living well with an awareness of dying.

“While there is a growing body of research focused on select aspects of people’s experiences with advanced cancer, there is little research examining the process of living with advanced cancer across the trajectory towards death,” says Robinson. “Even patients whose prognosis is limited are living longer and want to live well, making this issue a global concern.”

Robinson notes that globally there are 14.1 million new cancer cases diagnosed each year, 8.2 million cancer deaths, and 32.6 million people living with cancer. Historically, researchers have studied the concept of living well with a , but not specifically cancer. Robinson says those studies convey the idea it may be possible to live well with advanced cancer, but little is known about how it is done or how to support it.

The study analyzed 22 interviews with Spanish residents involved in previous research that explored their experience of living with advanced cancer. The researchers found the engaged in a five-phase iterative process: struggling, accepting, living with advanced cancer, sharing the experience and reconstructing life. This process revolved around participants’ awareness of dying, which differed from people living with chronic illness and was a unique aspect of this newresearch.

Each phase was revisited, and as the disease advanced living well got more challenging. Participants talked about strategies for living with advanced cancer, including making life adjustments, maintaining a positive attitude, normalizing and hoping.

Over time, participants realized struggling against the disease created additional difficulties. In fact, they understood it was counterproductive so they made a conscious choice to let go of struggling. Some referred to it as being the only choice they could make while living with the uncertainty of advanced cancer. This enabled accepting their life circumstances at some level and learning to live alongside their illness.

Robinson says that the importance of family love and support cannot be underestimated. For all the participants, she adds, awareness of dying led them to focus on living well. Sharing the experience with loved ones softened suffering remarkably. They were aware they did not have time to lose.

“Although it might happen in moments, participants were able to put behind them and live life rather than living their illness,” she notes. “Living in the moment enabled deep appreciation of everyday things such as the beauty of a flower garden.”

Robinson says the key takeaways to living well encompass a balance between dependence and independence, being able to see the positive and maintaining hope even in the end stages of the disease.

“The participants in this study worked hard to live a life rather than live an illness,” says Robinson. “The implication here is to support the positive. It has been found in previous research that hoping for a cure when is advanced is not lack of awareness—it can be a choice in focusing simply on positive possibilities.”

Complete Article HERE!

The Game Of Death: You Win By Talking About Yours The Best

By Gabrielle Emanuel

It’s game night on the top floor of a bank building in Medford, Mass., and 25 people have divvied themselves up around the circular tables. Four women, none of whom know each other well, are seated near the snacks busily discussing their future burials.

Katie Wallace, a native of nearby Somerville, is confident she wants to be cremated. But it’s a bit more complicated for her. The urns are accumulating. “I have a room in my house where I have the ashes of six different people,” she says. “So I have to figure out what to do with all of those people.”

As a lavender dusk settles outside the floor-to-ceiling windows, the women chuckle about whether Wallace should pass this “inheritance” on to a younger relative or, perhaps, invest in a columbarium.

This isn’t just small talk. It’s part of the game. These woman and men, all of whom are older, have gathered to play a card game — one with chips, a deck of cards, and a winner and losers. But this isn’t poker or blackjack.

Question 15: What music do you want to be listening to on your last day alive?

The game, called My Gift of Grace, aims to facilitate conversations about the end of life. It’s part of a growing trend: efforts aimed at encouraging talk of death well before it is imminent. From The Conversation Project to Honoring Choices and another card game called Go Wish, all seek to find ways around the usual distaste for facing death in advance, so that people can better control the care they receive at the end.

“I think we are on the early cusp of what I hope will become a groundswell of change,” said Dr. Lachlan Forrow, director of the Ethics and Palliative Care Programs at Boston’s Beth Israel Deaconess Medical Center, in a phone interview.

The idea for this game started when The Action Mill, a Philadelphia-based design firm, was interviewing a hospice nurse, remembers Nick Jehlen, who ultimately led the game’s design team.

“She said: ‘The most important thing you could do to make my job easier would be if you could make sure that everybody who shows up for me has had one conversation about the end of their life with their family, just one.’ ”

Dr. Forrow says that having that one conversation is a lot harder than it sounds; for most people, talking about death is incredibly difficult. “It is like the biggest, existential, overwhelming, huge issue for anybody: that we are mortal.”

But Jehlen and his team weren’t deterred. They set out to make that conversation a little bit easier.

A Game About The End Of Life

The first step for the design team was thinking about everything they wanted for the end-of-life conversation: they wanted it to be done in person, with a family sitting around a table together, and everyone having a pleasant time.

A card game checked all the boxes. “Nobody gets together with their buddies to play poker just to pass some cards and some chips around,” Jehlen says. “They actually go to tell stories and share insights.”

Susanne Wilkinson, one of the women sitting with Katie Wallace in Medford, says the idea of a game about the end-of-life made her “a little dubious,” but, she says, “I am more curious to see what comes out of this.”

Wilkinson, of Somerville, is willing to withhold judgment. She believes that “as a society we haven’t done this very well yet, so I am looking for any angles that might provide some avenues.”

Jehlen and the rest of his design team had the same thought. So they designed a deck of cards with a different question printed on each card.

Question 3: Write your own epitaph in five words or less.

Question 5: If you needed help going to the bathroom today, who is the first person you would ask to help you? Who would you never be able to ask?

Question 11: In order to provide you with the best care possible, what three non-medical facts should your doctor know about you?

Question 15: What music do you want to be listening to on your last day alive?

Every person answers the questions, and the other players decide whether an answer deserves a ‘thank you chip.’ The blue poker chips are meant to express gratitude for a thoughtful answer, and it’s those chips that end up determining the winner.

Jehlen says the design team wanted everyone in the family participating. The goal was to avoid focusing solely on the one person that might be nearing the end of their life.

Wilkinson particularly appreciated this element of the game. While death can be a lonely experience, she thought “the fact that it allowed you to connect with other people makes it satisfying.”

The game also sought to focus on life as well as death, since having a good death experience is often about understanding what one values in life.

Jehlen says he struggles to capture the game in words. “The problem we always run into is explaining the game is a little bit like explaining a joke.”

But he can’t remember a My Gift of Grace game where there wasn’t laughter. Recently, he was with a group of health care professionals, “in the middle of these 25 people playing the games,” he remembers. “I closed my eyes and it was just like rolls of laugher.”

Dr. Forrow was not involved in the development of the game but when he checked it out he found it to be “a wonderful blend of serious and humor.” He says that’s important but he tempers his enthusiasm.

Is The Game A Winner?

Dr. Forrow believes the jury is still out. He says there is one ultimate test for this game and for all the other efforts to facilitate an end-of-life conversation.

“We’ll find out whether it’s helpful or not by seeing people using it,” Dr. Forrow says.

The Action Mill has sold about 2,000 games since it went on sale in December.

Dr. Forrow thinks a lot more people need to be having this conversation. And, despite seeing progress, he says, “I don’t actually think anybody is yet doing a good job.”

In an effort to get more people playing the game and having the conversation, Jehlen and his colleagues had the idea of public game nights. Wallace and Wilkinson attended one of the 10 games nights that have been held across the country so far.

While the game was designed for families to play during the holidays, Jehlen says, “the feedback we started hearing was that actually playing the game, talking about end-of-life issues with strangers seemed like it was easier than maybe having this conversation with your family.”

Wallace would agree, but she has a word of warning. She says it’s comfortable either with “complete strangers or very close friends.” But when these game nights happen in small communities, there is the possibility of seeing “people you know in a very casual way,” and that, she says, is “a little odd.”

Jehlen has been viewing these public game nights as something of a warm-up for a family game night. But it’s not just families and strangers, it’s health care professionals too.

Where Does Medicine Come In?

To Jehlen’s surprise, “many of the people who are buying and playing the game are actually health care professionals.” About a third of their sales have been to hospitals, hospices and other health care groups.

On the one hand, this could be a vote of confidence for the game. But on the other hand, Dr. Forrow says, it’s helpful to have this end-of-life conversation in a non-medical context. He worries that when sitting in a doctor’s office, medical concerns dominate the conversation.

“I adamantly, firmly believe that for the conversations to be really about what really matters that they should start maybe even as far away from the hospital doctor’s office as they can,” Dr. Forrow says, “because these are much more fundamentally human issues than medical issues.”

Despite that fundamental nature of the topic, Dr. Forrow believes that it can be helpful not to think about it in such broad terms. “I think focusing on some simple concrete task that you did or did not do, like designating a health care proxy,” can make it easier, he says.

Jehlen admits there aren’t yet clear, concrete steps to take after playing the game. While many of the questions in the deck have a medical undertone, right now there isn’t a guide to help people translate game answers into a Living Will or an Advanced Care Directive. Although, he says, the game’s maker is considering putting downloadable end-of-life care forms on the website.

Regardless of what the next official steps may be, Susanne Wilkinson knows her next move: Before leaving game night, she said she wanted to borrow the game and play it again.

Complete Article HERE!

Washington State Weighs New Option After Death: Human Composting

A green burial plot at the Woodlawn Cemetery in Snohomish, WA

By Kirk Johnson

Leslie Christian recently added unusual language to her living will: After death, she hoped her remains would be reduced to soil and spread around to help out some flowers, or a tree. In essence, compost.

“It seems really gentle,” said Ms. Christian, 71, a financial adviser. “Comforting and natural.”

A bill before the Washington State Legislature would make this state the first in the nation — and probably the world, legal experts said — to explicitly allow human remains to be disposed of and reduced to soil through composting, or what the bill calls recomposition.

The prospect has drawn no public opponents in the state capital as yet, but it is a concept that sometimes raises eyebrows. Funeral directors say a common reaction to the idea, which has been explored and tested in recent scientific studies, is to cringe.

“There’s almost a revulsion at times, when you talk about human composting,” said Brian Flowers, the managing funeral director at Moles Farewell Tributes, a company north of Seattle that supports the bill.

In truth, composting is an ancient and basic method of body disposal. A corpse in the ground without embalming chemicals or a coffin, or in a quickly biodegradable coffin, becomes soil over time.

But death certificates in many states include a box that must be checked for burial or cremation, with no other options. Aboveground composting, through a mortuary process that requires no burial or burning of remains, is a new category without regulation about how it should be done or what can be done with the compost. What that means is that hardly any funeral director — even in states where laws about human remains are loosely worded — would risk offering it without state permission.

Pete Seeger, the folk singer, crooned about the idea: “If I should die before I wake, all my bone and sinew take. Put them in the compost pile to decompose a little while,” goes the song “In Dead Earnest.”

“When radishes and corn you munch you may be having me for lunch.”

In America, there are regional patterns to what comes of bodies after death. In the South and Midwest, where religious or cultural traditions run deep, more families opt for caskets and concretes vaults, and fewer choose cremation, experts say. In the Northeast, where family roots sometimes extend back centuries, people often favor burial in local cemeteries alongside ancestors.

In the Pacific Northwest, by contrast, death is treated somewhat differently, for reasons that sociologists and religious experts have long pondered. It’s a region where transient newcomers have defined the culture since pioneer days. Church attendance is among the lowest in the nation. Preservation of the environment is a central concern.

In Washington State, a larger percentage of residents are cremated than in any other state. Washington has more “green cemeteries,” which encourage a return to nature without manicured lawns and chemicals, than most states; only California and New York have more. And laws allowing physicians to help terminally ill patients hasten their deaths, known as “death with dignity,” were pioneered in the Pacific Northwest.

“It’s this interesting combination of environmental sensibility and individual choice,” David C. Sloane, a professor of public policy at the University of Southern California, said of the Northwest region. Now the prospect of legalized human composting, he said, puts many of those regional impulses in a spotlight. “It’s a test case for seeing how people think,” he said.

A container used in a study of human remains and composting last year at Washington State University.

Jamie Pedersen, a Democratic state senator from Seattle, is leading efforts to pass the legislation to permit a composting process after death.

Democrats control both chambers of the State Legislature, and Mr. Pedersen, the bill’s sponsor, said he had enlisted support from Republicans as well. Gov. Jay Inslee, a Democrat, has taken no position, a spokeswoman said.

At a hearing this month, no one spoke in opposition, though a state association of funeral directors said that it hoped clearer information could be added to the bill about where composted remains could be distributed. It was uncertain, too, whether such a measure would be seen as a priority during a legislative session crowded with issues that may be easier for politicians to talk about and win points on.

The bill would also legalize a separate process sometimes known as water cremation or alkaline hydrolysis. Under that process, already legal in 16 states, bodies are dissolved using a mixture of heated water and lye, leaving behind bone fragments and a sterile liquid.

People are drawn to the idea of aboveground decomposition mainly for environmental reasons, Mr. Pedersen said. There’s no coffin, no chemicals, none of the fossil fuels that would be needed for cremation, and no expensive cemetery plot required. Some religious traditions also favor ideas of simplicity and of earth returning to earth.

Though the process sounds simple, it would not be cheap. Preliminary estimates suggest that it could cost at least $5,000 — less, perhaps, than an elaborate burial service, but more than the most basic cremation.

In a study last year at Washington State University, six bodies donated for the research were placed in a closed container, wrapped in organic materials like alfalfa, then bathed in a stream of air warmed by microbes, and periodically turned. Lynne Carpenter-Boggs, a professor of soil science and sustainable agriculture and the lead researcher in the study, said that after about 30 days, the bodies essentially became soil.

Fears that composted remains might smell bad or contain toxic elements — from dental fillings, for example, or pharmaceutical residues — were allayed, Dr. Carpenter-Boggs said. She said that the heat generated by micro-organisms broke down organic matter and pathogens, and levels of pollutants like cadmium and mercury were within federal limits.

“It certainly is feasible that families would take home a small portion that they could keep for a long time,” Dr. Carpenter-Boggs said. “Or families could bring home a small amount that would be interred into their landscape, placed under a loved one’s favorite tree, similar to what people do with cremains.”

Katrina Spade, the founder and chief executive of Recompose, a Seattle company that hopes to build the first facility to use the new method and conduct funeral services based around it, said the movement toward cremation — now used in more than half of deaths in the nation — has led to an erosion of essential rituals. Remains are often just picked up from a crematory, she said, and that’s that.

“This is not simply a process to convert bodies to soil; it’s also about bringing ritual and some of that ceremony back,” Ms. Spade said.

Ms. Christian, the woman who is hoping recomposition will be an option after she dies, says she has long been uncomfortable with the other choices. She has ruled out burial. And she does not like the idea of cremation because of environmental costs — emissions and climate impacts of fossil fuels used in the burning process. But her friends remain divided on the issue.

“The vast majority are like, ‘That is so cool,’” she said. “And then the other response is, ‘Oh, gross.’”

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