Don’t leave your health decisions to chance

It’s easy to put off making important decisions in life, especially health care decisions. They can be uncomfortable and complex. Yet taking time to discuss and document your health care wishes can bring peace of mind and lead to better health outcomes in the future.

By William Creech

It’s easy to procrastinate

There are so many things to do every day, an almost-limitless amount of “low hanging fruit” items to cross off the list. It’s easy to put off thinking about your health care wishes.

There are many more enjoyable things to plan and ponder, while considering your health care wishes can feel like a chore. When given a choice between planning a vacation or outlining your end-of-life wishes, it’s easy to pick the more fun, less distressing task.

You also may procrastinate because you believe these decisions can wait for a more appropriate time in the future. Unfortunately, the right time and circumstances never seem to line up.

Documentation of your wishes

Thinking through and documenting your health care wishes tells your family and health care team what kind of care you want if you are too ill to express your wishes yourself. This could occur if you’re terminally ill, seriously injured, in a coma, in the late stages of dementia or near the end of life.

Some decisions that you should document include when you want to be resuscitated by CPR, when and for how long you want to be placed on a mechanical ventilator, or if you want to be fed through a feeding tube.

Record your wishes in a legal form called an advance directive. This document isn’t just for older adults. Anyone over 18, regardless of state of health, can complete an advance directive. It’s only activated if or when you are incapacitated and cannot make health care decisions.

One type of advance directive, a power of attorney for health care, is preferred because it makes your care wishes known and designates a person to make decisions for you if you cannot speak for yourself. This person is called a “health care agent.”

When selecting your health care agent, remember this story:

Two leaders pondered a difficult decision and were united in their approach. But soon, the second leader started to second guess the decision. The first leader said to the second, “Now is not the time to be a fence straddler.”

As you select your health care agent, pick a person you trust to follow your wishes and hold firm to the decisions.

You can update an advance health care directive or power of attorney for health care at any time, such as after a new diagnosis, a change in marital status or if your thoughts about end-of-life care evolve.

Get better outcomes

Procrastinating health care decision-making is a serious matter, so the sooner you begin, the better the potential outcome.

In some cases, life can be prolonged using advanced technology like ventilators, vasopressors and surgery. It’s great to be an educated health care consumer and understand the available treatment options, but it’s also important to remain objective, and listen to and heed the advice of your health care team.

If your health care team is unsure of your wishes, they may insist on prolonging care or performing invasive treatments on your behalf. These actions can have serious negative side effects and result in low quality of life.

Documenting your wishes early ensures that you will get the medical care you want and need while avoiding unwanted heroic measures that may be harmful. It also relieves unnecessary suffering, and eases your family and friends of decision-making burdens during moments of crisis or grief. What a gift this is for them.

Tips for difficult decisions

These conversations and decisions are not easy, but they are important.

Here’s my advice on tackling difficult decisions with your family and friends:

Don’t kick the can down the road.

Sometimes getting started is the hardest part. Years ago, I drove a vehicle with a manual three-speed transmission on the column. Unlike the automatic engines found in cars today, you could give this car a small push downhill to start the engine. In the same way, some people just need a little push to get started.

Perhaps you feel the day will never come that you face a serious injury or illness or that you will die in your sleep. But nearly every family is affected by a serious illness or injury at some point. If decisions are put off and not documented, a well-intentioned but uninformed family member could make decisions that don’t align with your wishes. I have found this to be the case on many occasions. A rolling snowball in the form of unmet health care decision-making can lead to a big mess that can become a proverbial avalanche if left unheeded.

Don’t decide to do nothing.

Inaction is still an action. If you refuse to make difficult decisions in health care, you are still deciding, but it’s much riskier. It’s like gambling on a roulette wheel. You don’t know where the ball is going to stop. Instead of taking action to improve your odds, you are just hoping for a good outcome.

You take control by expressing your wishes and choosing a responsible health care agent in an advance directive. These actions guide your roulette ball by adding flappers on the wheel that align with your desires. Doing so can make the difference between comfort or chaos for you, your health care team and your family.

Keep points simple yet specific.

As you complete your advance directive, you will be advised to consider all options. This can feel overwhelming. The key is to keep it simple because there is no way you can cover every possible scenario.

Too often, advance directives are too generic or too detailed. I recommend a happy medium where some key themes are outlined and cover a myriad of scenarios. Keep it simple when you can.

Let professionals guide you.

When you are ready, find a health care professional to guide you through completing an Advance Directive booklet. Social workers and chaplains in health care organizations, along with faith leaders, community service workers in local communities and volunteers, are trained to assist you. Your primary care provider also can assist. These professionals will help you work through the decisions, but they won’t tell you what to do.

Advanced planning and outlining your wishes before you need the care gives you the opportunity to communicate your wishes with your family. Talk with them about your advance directive and health care wishes, along with your rationale behind the decisions. Give a copy to your health care agent and health care team.

It’s prudent to be a well-informed patient as you outline your health care wishes. They are not only life decisions, but also they’re life-altering.

Helpful links:

Complete Article HERE!

Americans are bad at talking about death, and it’s hurting the environment

The path to more eco-friendly burials starts with uncomfortable conversations about death

By Rachel Ashcroft

How often do you think about your own death? The answer is probably along the lines of “rarely, if ever.” Death denial is commonplace in the United States; indeed, in Western countries, people tend not to die at all, but “pass on” or “slip away” instead. Our own death, in particular, is something we try to avoid thinking about until we really have no choice in the matter.

This is perfectly understandable behavior. Thinking about death can be scary for many reasons, from fears about dying in pain to contemplating what happens after death. Longer lifespans and medical advances have made it easier to delay thinking about mortality. But death denial has many disadvantages, too. Avoidance can actually increase — not lessen — anxiety. We also risk leaving behind grieving loved ones who aren’t clear on our final wishes. Death denial is not just bad for individuals, either: There’s plenty of evidence to show that it is harmful to the environment, too.

Traditional funeral options are less than eco-friendly. In the U.S., some estimates suggest that cremation emits approximately 360,000 metric tons of CO2 each year. According to the Green Burial Council, heating a furnace at 2,000 degrees Fahrenheit for two hours produces roughly the same emissions as driving 500 miles in a car. Burials pose their own set of problems: Caskets and vaults use a large amount of natural resources. Casket wood alone requires the felling of 30 million board feet of wood in the U.S. each year, and thousands of tons of steel and concrete are used to construct vaults. Embalming fluid (which contains carcinogenic chemicals) can contaminate groundwater around cemeteries.

At a time when large corporations are regularly held to account for their green principles, the funeral industry is one of the few players to escape the scrutiny of its practices. A culture of death denial facilitates this situation. In a society where death is considered “morbid,” who wants to build their activism around something that most of us avoid discussing? Prominent figures like Greta Thunberg rarely venture into the murky world of deathcare. On Instagram, eco influencers are far more comfortable snapping pictures of avocado on toast than discussing the perils of embalming fluid.

Things weren’t always this way. In the early 1900s, Americans lived in close proximity to the dead and dying. Bedside vigils, in which the entire family gathered around a dying relative, were extremely common. Most people died in their home, leaving family members to prepare the body. Historians argue that this changed when end-of-life care moved to hospitals and funeral parlors began looking after dead bodies. Death became far less visible. When people today view an open casket, the corpse is altered so as to hide the physical effects of death. This evolution from death in close proximity to death being hidden and painted over has fueled a tendency toward death avoidance which, when compared to many other world cultures, is a complete anomaly.

Fortunately for our planet, change is on the horizon. Several environmentally-friendly deathcare options are springing up across the United States. From water burials to natural organic reduction or “human composting,” the green deathcare industry is taking root. But in order to fast forward the process of offering people legalized, eco-friendly deathcare choices, we have to talk more openly about death and dying to begin with.

In practical terms, avoiding death talk allows myths and assumptions about funeral care to flourish. Just over half of Americans choose cremation each year, partly due to a (false) perception that it’s good for the environment. Caitlin Doughty, a prominent mortician and “death positive” advocate, has also reported instances of bereaved families being informed that embalming is a legal requirement — it isn’t. No state requires embalming or even burial inside a vault. If you’ve lived your whole life trying to reduce your carbon footprint, understanding what is and isn’t legal can help make your death greener, too.

People often say they “want to be a tree” after they die. But when we don’t examine traditional deathcare closely enough, it’s easy to overlook the fact that ash from cremated remains doesn’t enrich soil, while traditional burial prevents bodies from mingling with the earth. Setting aside time to explore other funeral options reveals the different ways that our remains can help plants grow. “Green burial” generally describes an unembalmed body placed in a shroud or biodegradable coffin, which is lowered directly into the ground. This allows the body to decompose into the surrounding earth. No state laws forbid green burial, and a growing number of cemeteries are offering this service. Human composting uses a combination of microbes, oxygen, and organic matter to convert corpses directly into soil. It’s legal in Colorado, Oregon, and Washington, and bills are being considered in several other states.

There are some disadvantages to green deathcare. At the moment, price can be an issue. For society’s poorest, direct cremation (no viewing or visitation) costs as little as $1,000. Human composting, on the other hand, is priced between $7,000 to $10,000. There may also be religious issues pertaining to human remains; Washington’s legalization of human composting was opposed by Catholic groups who argued that composting didn’t show enough respect for the deceased body.

However, green deathcare will only become more affordable and widespread (for those who want it) if we learn how to talk about death in the first place. Of course, it can initially be uncomfortable to think about ourselves turning into ash or soil. But having as much information as possible about a topic is always empowering — even when it comes to your own death.

Complete Article HERE!

Penance and plague

— How the Black Death changed one of Christianity’s most important rituals

Confession, circa 1460/1470. Artist unknown.

By

The 14th century is known for catastrophe. By midcentury, the first wave of plague spread through a Europe already weakened by successive famines and the Hundred Years War between England and France. And crises just kept coming. After the first wave, which has come to be called the Black Death, the disease returned at least four more times before 1400. All the while, fresh conflicts kept erupting, fueled in part by the rising number of soldiers available for hire.

As a medieval historian, I study ways that community leaders used Catholic practices and institutions to respond to war and plague. But amid the uncertainty of the 14th century, some Catholic institutions stopped working the way they were supposed to, fueling frustration. In particular, the unrelenting crises prompted anxiety about the sacrament of penance, often referred to as “confession.”

This uncertainty helped spark critics like Martin Luther to ultimately break from the Catholic Church.

Saints and sacraments

During this era, European Christians experienced their faith predominantly through saints and sacraments.

In art, saints were depicted as standing near God’s throne or even speaking into his ear, illustrating their special relationships with him. Pious Christians considered saints active members of their communities who could help God hear their prayers for healing and protection. Throughout Europe, saints’ feast days were celebrated with processions, displays of candles, and even street theater.

Fourteenth-century Christians also experienced their faith through Catholicism’s most important rituals, the seven sacraments. Some occurred once in most people’s lives, including baptism, confirmation, marriage and extreme unction – a set of rituals for people who are near death.

A medieval manuscript with colorful illustrations depicts rites for people who are dying.
A 15th-century manuscript depicts deathbed scenes: doctor’s visit; confession; Communion; extreme unction; and burial. From the Bedford Hours of John, Duke of Bedford.

There were two sacraments, however, that Catholics could experience multiple times. The first was the Eucharist, also known as Holy Communion – the reenactment of Christ’s Last Supper with his apostles before his crucifixion. The second was penance.

Catholic doctrine taught that priests’ prayers over bread and wine turned those substances into the body and blood of Christ, and that this sacrament creates communion between God and believers. The Eucharist was the core of the Mass, a service which also included processions, singing, prayers and reading from the Scriptures.

Religious Christians also encountered the sacrament of penance throughout their lives. By the 14th century, penance was a private sacrament that each person was supposed to do at least once a year.

The ideal penance was hard work, however. People had to recall all the sins they had committed since the “age of reason,” which started when they were roughly 7 years old. They were supposed to feel sorry that they had offended God, and not just be afraid that they would go to hell for their sins. They had to speak their sins aloud to their parish priest, who had the authority to absolve them. Finally, they had to intend to never commit those sins again.

After confession, they performed the prayers, fasting or pilgrimage that the priest assigned them, which was called “satisfaction.” The whole process was meant to heal the soul as a kind of spiritual medicine.

Broken up by Black Death

Waves of plague and warfare, however, could disrupt every aspect of the ideal confession. Rapid illness could make it impossible to travel to one’s parish priest, remember one’s sins or speak them aloud. When parish priests died and were not immediately replaced, people had to seek out other confessors. Some people had to confess without anyone to absolve them.

A manuscript depicts people burying victims of the Black Death plague.
An illustration in the Annales of Gilles de Muisit, from the 14th century, depicts people burying victims of the Black Death.

Meanwhile, Europe’s frequent wars posed other spiritual dangers. Soldiers, for example, were hired to fight wherever war took them and were often paid with the spoils of war. They lived with the constant weight of the commandments not to kill or steal. They could never perform a complete confession, because they could never intend not to sin this way again.

These problems caused despair and anxiety. In response, people turned to doctors and saints for help and healing. For example, some Christians in Provence, in present-day France, turned to a local holy woman, Countess Delphine de Puimichel, to help them remember their sins, protect them from sudden death, and even leave warfare to become penitents. So many people described feeling consoled by her voice that a medical doctor who lived near the holy woman set up meetings so people could hear her speak.

But most people in Europe did not have a local saint like Delphine to turn to. They looked for other solutions to their uncertainties about the sacrament of penance.

Indulgences and Masses for the dead proved the most popular, but also problematic. Indulgences were papal documents that could forgive the sins of the holder. They were supposed to be given out only by the pope, and in very specific situations, such as completing certain pilgrimages, serving in a crusade, or doing particularly pious acts.

During the 15th century, however, demand for indulgences was high, and they became common. Some traveling confessors who had received religious authorities’ approval to hear confessions sold indulgences – some authentic, some fake – to anyone with money.

Catholics also believed that Masses conducted in their name could absolve their sins after their death. By the 14th century, most Christians understood the afterlife as a journey that started in a place called Purgatory, where residual sins would be burned away through suffering before souls entered heaven. In their wills, Christians left money for Masses for their souls, so that they could spend less time in Purgatory. There were so many requests that some churches performed multiple Masses per day, sometimes for many souls at a time, which became an unsustainable burden on the clergy.

An eagle's-eye photograph shows a graveyard being exhumed.
A Black Death burial trench under excavation between rows of individual graves and the later concrete foundations of the Royal Mint in East Smithfield, London.

The popularity of indulgences and Masses for the dead helps scholars today understand people’s challenges during the Black Death. But both practices were ripe for corruption, and frustration mounted as a sacrament meant to console and prepare the faithful for the afterlife left them anxious and uncertain.

Criticisms of indulgences and penance were a focus of reformer Martin Luther’s famous “95 Theses,” written in 1517. Though the young priest did not originally intend to separate from the Catholic Church, his critiques launched the Protestant Reformation.

But Luther’s challenges to the papacy were not ultimately about money, but theology. Despair over the idea of never being able to perform an ideal confession led him and others to redefine the sacrament. In Luther’s view, a penitent could do nothing to make satisfaction for sin, but had to rely on God’s grace alone.

Complete Article HERE!

A New Take on Death and Dying

In “The Future of the Corpse,” co-editors Karla Rothstein and Christina Staudt review the spectrum of death and offer ideas for change.

Christina Staudt, left, and Karla Rothstein are co-editors of “The Future of the Corpse.”

By Eve Glasberg

Around the globe, roughly 165,000 people die every day. The Neanderthals were the first human species to bury their dead, entombing them with stone tools, animal bones, and other artifacts in shallow graves.

The Future of the Corpse: Changing Ecologies of Death and Disposition, edited by architect and GSAPP Professor Karla Rothstein, founder and director of the GSAPP DeathLAB, and Christina Staudt, co-chair of the Columbia University Seminar on Death, reviews the spectrum of death.

American society today is in a pivotal period for reimagining end-of-life care, funerary services, human disposition methods, memorializing, and mourning. The book’s editors and contributors outline the past, present, and future of death care rituals, pointing to promising new practices and projects that better integrate the dying and dead with the living, and create positive change that supports sustainable stewardship of the environment.

Rothstein and Staudt discuss the book with Columbia News, as well as what it was like to collaborate on the volume, and who they would invite to a joint party.

Q. What was the impetus behind this book?

Karla Rothstein: After discovering my graduate architectural design studio syllabi online a decade ago, Christina invited me to present to and then join the University Seminar on Death. In 2016 the seminar and GSAPP DeathLAB jointly organized a daylong colloquium—Designing for Life and Death—which brought academics and industry stakeholders together to probe New York City’s relationship with death, corpse disposition, and the potential for new forms and civic-sacred space. This book contains chapters by many of the colloquium’s interdisciplinary panelists, sharing their expertise on the complex and evolving aspects of dying, death, and remembrance.

Christina Staudt: The colloquium produced so many substantive and thoughtful ideas that we felt compelled to bring the content to a larger audience in a comprehensive volume on postmortem issues.

Q. What are some of the innovative projects and practices in the book that better integrate the dying and dead with the living, and create positive change supporting sustainable stewardship of the environment?

KR: Many cemeteries across the globe are facing dire limits on burial space. Cemeteries are cultural assets and provide crucial open space in dense cities, but the American expectation of a burial plot in perpetuity for each individual is at odds with the density and spatial limits of urbanity. The resource consumption of prevailing casketing and cremation practices are also considered wasteful by those prioritizing ecological impact.

Cemeteries can serve their current communities through new, sustainable forms of corpse disposition that engage the body biologically, and contribute to enduring civic-sacred spaces supporting grief and remembrance. We and others are developing mortuary options that are gentle on the earth while also remaining proximate to where we live.

CS: A growing rejection of embalmment and resource-intensive coffins among environmentally conscious families parallels a movement toward direct disposition—i.e., the body is moved from the deathbed directly to the burial site. More time is spent with the deceased at the site of death—where the family washes and cares for the body—rather than having the corpse whisked away to a funeral home. Individualized rituals and services that reflect the character of the deceased, often planned in advance with family and loved ones, occur by the deathbed and the place of final disposition. Advocates of green burial are leading the way.

Q. How has COVID accelerated and highlighted the need to address the changing death-care landscape?

KR: Never before in our lifetimes has death been so present. Society has a desperate need for spaces of healing—from the traumas of COVID, as well as other forms of grief and grievances, including confronting and repairing racial, environmental, and economic injustices. Civil and dignified contexts are crucial to societal care. A sense of community and ritual are important scaffolds around life’s transitions, and we need options and practices commensurate with current individual values and planetary priorities. Relative to just a decade ago, the public interest and willingness to engage in discussions of death and disposition are truly remarkable.

CS: The sheer volume of pandemic fatalities alone would have forced healthcare industries and the funerary complex (funeral directors, crematories, and cemeteries) to retool their practices, but the necessity to isolate because of COVID has been a stronger impetus to change. Telemedicine, deathbed goodbyes on Facebook, Zoom funeral planning, livestreaming and recording of funerary services, and online memorializing have all advanced exponentially, and are here to stay.

The social inequities of the pandemic, with much higher death rates for the poor and minorities, has added urgency to our need to address systemic change.

Q. What was it like to produce a book together?

KR: We both have high standards, and we’ve earned each other’s trust and respect. We have different styles: We’re both pragmatic idealists, but Christina is perhaps more straightforward, and I sometimes tend toward the poetic. We complement one another well.

CS: The collaborative process was pleasantly smooth. Karla and I hardly ever disagreed. Rather than feeling I was compromising my position in discussions about the book, I found that our dialogues gave me new insights and expanded perspectives.

Q. Have you read any books lately that you would recommend, and why?

CS: In Notes on Grief, Chimamanda Ngozi Adichie shares her experience after the death of her father during the pandemic. She allows her pain and reactions to emerge on the page with compelling power. Her suffering, questioning, search for meaning, and desire to honor her deceased father touch on themes common in bereavement—the bodily sensation of grief, the failure and support of rituals, the need for time and space alone and for community. Her dual project of memorializing and finding a way to live with grief is a gift to the reader.

KR: I would add Elizabeth Kolbert’s recently published Under a White Sky. I haven’t read it yet, but it’s a continuation of her excellent research and writing on the impacts we humans have wrought on the planet, and I reference her earlier The Sixth Extinction regularly. Taking responsibility for the consequences connected to our actions is a timeless ethical imperative.

Q. You’re both hosting a dinner party. Which three academics or scholars, dead or alive, would you invite, and why?

CS: With no restrictions to the invitation list, I will aim high: It would be a treat to reunite the Dalai Lama and Archbishop Desmond Tutu, so they can continue their charming lunch banter, recounted in their The Book of Joy— Lasting Happiness in a Changing World. As a foil to these two “mischievous” (as they describe themselves in the book), male faith leaders, I will invite a female atheist who can match their wit, perhaps the Barnard graduate Zora Neale Hurston, or maybe the early women’s rights leader, Ernestine Rose, said to possess “a rare sense of humor.”

We may end up touching on postmortem issues directly, but no matter where the talk leads, mortality remains foundational to human life and is never fully absent.

KR: My days are overflowing with teaching, research, and the building projects of my architecture practice, so I would be thrilled to participate in this exceptional evening!

Complete Article HERE!

What is palliative care?

How is it different from hospice?

Palliative care tries to support a patient’s quality of life.

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When most people hear the term palliative care, they look worried or confused. Introducing myself to patients and families as a palliative medicine physician, I commonly hear things like, “Does this mean I am dying?” or “I am not ready for hospice.”

I respond by acknowledging these common fears, but emphasizing that palliative care and hospice care are two very different things.

Hospice care is a Medicare-covered benefit for people whose doctors believe they are in the last six months of life, and who want to stop treatments targeting their disease – such as chemotherapy for cancer – to focus on comfort. In contrast, palliative care is appropriate for people at any stage of serious illness and is provided alongside treatments aimed at curing disease.

Palliative care specialists like me are experts in treating physical symptoms like pain and nausea. But just as important, we listen to patients’ stories and find out what is most important to them. We help make difficult treatment decisions and address the sadness and uncertainty that often accompany serious illness. We walk alongside patients and their families at a time that can be frightening and overwhelming, offering comfort, information, guidance and hope.

Palliative care recognizes that ethical and compassionate care for serious illness requires supporting the whole person in addition to fighting the disease.

Mounting evidence

The field of palliative care is still relatively new. In the early 1990s, research demonstrated substantial shortcomings in the quality of care for patients with serious illnesses. One 1995 study of nearly 5,000 people in the U.S. found that half of patients who died in the hospital experienced moderate to severe pain in their last days of life. More than half of the time, doctors did not know when their patients preferred to avoid CPR at the end of life.

These types of findings helped inspire the field of palliative care over the course of the 1990s and early 2000s. It began at a handful of hospitals as a specialty consult service working alongside primary teams – such as oncologists, cardiologists, surgeons and neurologists – to improve the experience of serious illness and ensure patients’ needs were met.

According to the State-by-State Report Card on Access to Palliative Care, which is compiled by researchers at the Center to Advance Palliative Care, only 7% of U.S. hospitals had a specialty palliative care service in 2001. Today, 72% of hospitals with 50 or more beds have a palliative care service, and palliative care specialists are increasingly available in other settings as well, including outpatient clinics, nursing homes and home-based programs. For example, it is now possible to see an oncologist for cancer treatment or a cardiologist for heart failure, followed by an appointment with a palliative care specialist who treats related symptoms such as fatigue and depression.

This growth is fueled in part by growing evidence of the benefits that palliative care provides for patients and families. Our research team at the University of Pittsburgh led a 2016 review of results from 43 randomized trials with nearly 13,000 patients – meaning that some patients received palliative treatment, and others did not. We found that palliative care was associated with significant improvements in patients’ quality of life and reductions in their physical symptoms one to three months afterward.

A woman in a hospital bed, in a hospital gown, smiles and pets a fluffy dog as another woman looks on.
Palliative care involves discussing what matters most to a patient’s quality of life, such as being able to care for their pets.

Importantly, palliative care was not associated with shortened survival, pushing back against a popular assumption that pursuing palliative care means “giving up” on fighting disease. In fact, one influential study found that patients with advanced lung cancer who receive specialty palliative care in addition to standard oncology care lived almost three months longer than patients who received standard oncology care only.

Palliative care is now recommended in many national guidelines as a critical component of high-quality care for serious illnesses. For example, in 2016 the American Society of Clinical Oncology recommended that all patients with advanced cancer receive dedicated palliative care services early after diagnosis, while also receiving treatment to target the disease. Increasingly, palliative care is viewed as an essential part of ethical and compassionate medical care.

Not the norm

One might suspect that an evidence-based service recommended by national guidelines would be available to everyone with serious illness. When it comes to palliative care, however, this is not the case.

Nationally, palliative care teams are vastly understaffed. Workforce shortages are projected to worsen in the future, as the U.S. population ages and therapeutic advances mean people can live longer with serious illness. Even now, with COVID-19 surges having caused as many as 154,000 new hospitalizations weekly and made other patients sicker because of pandemic-related delays in care, palliative teams are stretched to the limit.

Whether you or a loved one has access to palliative care may also depend on where you live and where you receive your medical care. According to the State-by-State Report Card, a hospital in New Hampshire is three times more likely to have a palliative care service than a hospital in Mississippi. Another recent analysis found that a not-for-profit hospital is two times more likely to have a palliative care service than a for-profit hospital.

A 2019 study found that palliative care consults were less frequent at hospitals that serve the largest proportions of Black and Hispanic patients. These structural inequities risk worsening known disparities in the care of serious illness.

Educating doctors

Patients and families can request palliative care, but palliative care specialists usually are brought in once the primary clinical team recommends it. Yet many physicians do not, either because they mistakenly equate palliative care with hospice or do not recognize the value that palliative care can bring.

One approach to expanding palliative care access is to enhance palliative training and support for every clinician who cares for patients with serious illness – an approach sometimes called “primary” palliative care. Another approach is to leverage newer care-delivery models, such as telemedicine, to expand the reach of palliative care specialists.

These solutions would require changing medical reimbursement and training models to make palliative care fundamental – for everyone.

Complete Article HERE!

What Does It Mean If You Dream About Dying?

No need to start planning your own funeral.

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Fear not! Dreaming of a death or of dying doesn’t have to be literal, and it doesn’t mean you or a loved one will die! Trust me: My name is Valeria Ruelas, and I’m a bruja.

The Mexican Witch Lifestyle: Brujeria Spells, Tarot, and Crystal Magic

Dreams are complex and symbolic, and so it is important to identify the type of dreams you have before you get into the meaning. If you have a dream that seems significant to you, it’s important to sit with your intuitive feelings and thoughts after you wake up. You might consider keeping a dream journal and spending each morning reflecting on the meaning of your dreams. But if you wake up and think, “Hey, that was silly,” then no need to try to interpret your dream—sometimes they really are just pointless!

There are a few types of dreams you might have: Prophetic dreams, which predict the future; dreams about anxieties, which are a signal to work on managing your worries; pointless dreams, which just seem random; and dreams from your spirit guides, which may be instruction-heavy or have a moral lesson.

Now let’s get specific: If you dream about dying, what exactly does it mean?

What does it mean if I dream about myself dying?

Don’t worry: This doesn’t mean you’re going to die! To get more info, look at the way you die in your dream. If you die a violent death, then that means you should be careful and watch out for recklessness, immediate dangers, and enemies. If you have a peaceful death, look at the dream as a symbol of moving on, graduating, changing, or spiritual awakening. A dream about dying may also mean that you need to make an effort to forget a person or experience; you need to move on from something. Finally, like these dreams can sometimes have to do with trauma.

What does it mean if I dream about a family member or loved one dying?

This is one of those dreams I encourage people to ignore! However, it can also be an encouragement to leave your home, your city, or your comfort zone. Think about what’s been on your mind lately and if your dream relates.

What does it mean if I dream about a pet dying?

Like dreaming about a loved one dying, this dream may be also about sadness or feelings of abandonment. However, personally I would schedule a check-up with the vet, just in case!

What does it mean if I wake up just before I die a dream?

This type of dream could mean that you are supposed to figure something out from the clues. I would pay extra close attention to what is said in dialogue in these dreams, as they can be instructive about how you should live your life and what decisions you should make.

What does it mean if I have recurring dreams about dying?

Usually, dreaming about dying simply means that you are a worrier. It also could mean you’re not getting enough rest. It does *not* mean that you are doomed!

Books About Dream Interpretation

The Alchemy of Your Dreams: A Modern Guide to the Ancient Art of Lucid Dreaming and Interpretation
The Alchemy of Your Dreams: A Modern Guide to the Ancient Art of Lucid Dreaming and Interpretation
The Oracle of Night: The History and Science of Dreams
The Oracle of Night: The History and Science of Dreams
The Dream Dictionary: An A-Z guide to dream symbols and psychology
The Dream Dictionary: An A-Z guide to dream symbols and psychology
The Guided Dream Journal: Record, Reflect, and Interpret the Hidden Meanings in Your Dreams
The Guided Dream Journal: Record, Reflect, and Interpret the Hidden Meanings in Your Dreams

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Death, Dying and Suffering

— The Need for Medical Education Reform

by and

As she closed the door behind her, the palliative care geriatrician whom I (Meghan) was shadowing turned and said, “Remember, there are no difficult patients – just difficult situations.” We walked to our next patient, Mrs. C, who was suffering from congestive heart failure. All cures had been exhausted and she was tired of being at the hospital but was scared to enter hospice care. The doctor clasped hands with Mrs. C and explained that starting hospice did not mean giving up — it meant living life on her own terms in the time that was left. After these discussions, Mrs. C appeared more at ease and decided to pursue hospice care at her home.

During this and other palliative care consults, I saw how terminal illness could raise tough questions with patients, families and their providers. However, I also saw that working through these discussions could minimize suffering, give patients a sense of hope and allow them to make the most of their time remaining. Unfortunately, most medical students and doctors report feeling ill-equipped to have conversations about end-of-life care with patients. In this article, we will examine a provider’s role in validating the illness experience and describe how formal medical training on death, dying and suffering can equip physicians to provide better patient care.

According to medical humanist and physician, Eric Cassel, suffering can be defined as a state of distress that occurs when a person’s “intactness … as a complex social and psychological entity” is threatened. Suffering can occur when pain is uncontrollable, chronic or when its source is unknown. Patients may suffer and feel helpless when experiencing such pain due to a lack of perceived control or knowledge of how to relieve it. However, physical pain is just one aspect; there are also psychological, existential and social dimensions that can exacerbate suffering. I (Leonard) lived through this complex experience of suffering secondary to a debilitating illness when I was 19. I had an unusual Clostridioides difficile (C. diff) infection lasting several weeks which was so severe that it caused me to lose 15 pounds. During this period, I felt the uncertainty, vulnerability and alienation associated with being sick. Because it was so rare for a healthy, immunocompetent individual like myself to contract C. diff, it took a week and a half before my doctors were able to diagnose the medical origin of my suffering. To make matters worse, I felt that the doctors cared more about my atypical case of C. diff than about me as a human. Being solely viewed as an “interesting presentation of disease” invalidated my experience and caused me to suffer beyond the pathogenesis of the bacterial infection.

Physicians must work with their patients to identify the underlying and often complex sources of distress. Once a culprit has been identified, a physician can help the patient manage the aspects of distress which they can control, reframe their perceptions and interpretations of the aspects that they can’t control, and ultimately, reassure them that the distress will eventually end. In essence, physicians can empower patients to take control over their distress, thus reducing their suffering.

Regardless of their chosen medical specialty, physicians will inevitably confront death, dying and suffering during their education, training and career. However, due to the curricular gaps in our current medical education system, future physicians are underprepared to hold such conversations with their patients. Indeed, one survey of medical students at two prominent medical schools reported that students received “little or no explicit educational attention to the suffering of patients and their families” or for the clinical management of suffering. Instead, the students learned these clinical skills primarily by ad hoc observation of role models. While ad hoc observation can be a powerful learning method, it could be much more effective when used in tandem with more formal instruction. Not only does this unpreparedness result in suboptimal care, but it may even harm patients, who can suffer more from not feeling heard, validated or supported when discussing their illness with providers.

Medical school curricula should be formalized to teach students how to face suffering and death in clinical practice. We advocate for a longitudinal educational approach: first, incorporating curricula on suffering and death in didactic pre-clinical education will afford students the opportunity to learn foundational concepts, such as how to address suffering and openly discuss death, in a safe space. Secondly, to maximize student learning in the pre-clinical years, lived experience panels and group discussions following the panels may also prove useful; composed of people who have direct, firsthand experience with a particular topic, lived experience panels offer a personal lens through which to view the issue. For suffering and death education, lived experience panels may include patients with terminal illnesses (and their families), palliative care specialists and people living with chronic diseases.

At the University of Texas Medical Branch, we attended such panels during one of our first-year medical courses and found them to be profoundly insightful. These panels deepened our understanding of what patients and families had experienced and demonstrated how providers could better acknowledge and support patients’ needs. Early exposure to formalized curricula on suffering and death through lived experience panels will encourage budding physicians to inquire about their patients’ values throughout all stages of their lives.

Patients deserve to live their lives with dignity. From our experiences, we understand that suffering may interfere with this and cause patients to lose hope. Medical education must address death and suffering early so that such conversations are normalized amongst medical students by the time that they reach the clinical years. By incorporating more instruction on how to acknowledge distress and suffering in medical school curriculum and by learning directly from patients and families, future physicians will be able to work with patients to find the best balance between quantity and quality of life.

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