Category: Death Education

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When Patients Choose to End Their Lives

For some, the decision to die is more complicated than a wish to reduce pain.

By Jane E. Brody

At a time when so many are dying against their will, it may seem out of sync to discuss the option of having a doctor help people end their lives when they face intolerable suffering that no treatment can relieve.

It’s less a question of uncontrollable physical pain, which prompts only a minority of requests for medical aid in dying, than it is a loss of autonomy, a loss of dignity, a loss of quality of life and an inability to engage in what makes people’s lives meaningful.

Intractable suffering is defined by patients, not doctors. Patients who choose medical aid in dying want to control when they die and die peacefully, remaining conscious almost to the very end, surrounded by loved ones and able to say goodbye.

Currently, nine states and the District of Columbia allow doctors to help patients who meet well-defined criteria and are on the threshold of dying choose when and how to end their lives. The laws are modeled after the first Death with Dignity Act, passed in Oregon in 1997.

A similar law has been introduced repeatedly, and again this January, in New York. Last year, Maryland came within one vote of joining states that permit medical aid in dying. Diane Rehm, the retired National Public Radio talk show host, says in a new film she created on the subject, “Each of us is just one bad death away from supporting these laws.”

Most people who seek medical aid in dying would prefer to live but have an illness that has in effect stripped their lives of meaning. Though often — and, proponents say, unfortunately — described as “assisted suicide,” the laws hardly give carte blanche for doctors to give people medication that would end their lives quickly and painlessly. The patient has to be terminally ill (usually with a life expectancy of less than six months), professionally certified as of sound mind, and able to self-administer the lethal medication without assistance. That can leave out people with advanced dementia or, in some cases, people with severe physical disabilities like those with amyotrophic lateral sclerosis (A.L.S., or Lou Gehrig’s disease).

A desire to broaden access to medical aid in dying prompted Ms. Rehm to create the film “When My Time Comes” to air on public television starting April 8. (A free livestream of the film preview and discussion will be available on April 8, at 12:45 p.m. Eastern, at weta.org/WhenMyTimeComesFilm.) The film follows the 2020 publication of Ms. Rehm’s book of the same title, subtitled “Conversations About Whether Those Who Are Dying Should Have the Right to Determine When Life Should End.” Both the book and film were inspired by the protracted death in 2014 from Parkinson’s disease of John Rehm, her first husband, to whom she was married for 54 years.

Mr. Rehm, then living in Maryland, could no longer stand, feed or toilet himself, but his doctors could not legally grant his plea to help him die quickly. Instead, the only recourse he was given was to refuse all food, liquid and medication, which ended his life 10 days later.

This is still the only option doctors can legally “prescribe” for the overwhelming majority of Americans who live in the 41 states that have yet to pass a medical aid-in-dying law. The approach does indeed work, but it’s not an acceptable choice for many dying patients and their families.

Ms. Rehm said her goal is that no patient should have to suffer the indignity her husband experienced at the end of his life. She described his death as “excruciating to witness,” even though after about two days the absence of food and water is usually quite tolerable for the patient.

Dr. Jessica Nutik Zitter, a palliative care physician at Highland Hospital in Oakland, Calif., said in an interview, “The concept of medical aid in dying is gaining acceptance, but it takes a while for people to be comfortable with it. Doctors are trained to just keep adding technology to patient care regardless of the outcome, and withdrawing technology is anathema to what we’re taught.”

As a result, doctors may convince dying patients and their families to accept treatments “that result in terrible suffering,” said Dr. Zitter, author of the book “Extreme Measures: Finding a Better Path to the End of Life.” In her experience, a fear of losing control is the main reason patients request medical aid in dying, but when they have access to good palliative care, that fear often dissipates.

Only a third of patients who qualify for medical aid in dying actually use the life-ending drugs they get, she said, explaining that once given the option, they regain a sense of autonomy and no longer fear losing control. In a study of 3,368 prescriptions for lethal medications written under the laws in Oregon and Washington state, the most common reasons for pursuing medical aid in dying were loss of autonomy (87.4 percent); impaired quality of life (86.1 percent), and loss of dignity (68.6 percent).

Of course, many doctors consider medical aid in dying contrary to their training, religious beliefs or philosophy of life. Dr. Joanne Lynn, a geriatrician in Washington, D.C., who is not a supporter, said the emphasis should be on providing better care for people who are very sick, disabled or elderly.

“We should resist medical aid in dying until we can offer a real choice of a well-supported, meaningful and comfortable existence to people who would have chosen a medically assisted death,” Dr. Lynn said. “There’s currently no strong push for decency in long-term care. It’s not a real choice if a person’s alternative is living in misery or impoverishing the family.”

Barbara Coombs Lee, president emerita of Compassion & Choices, a nonprofit organization in Portland, Ore., that seeks to expand end-of-life options, said, “The core principle of medical aid in dying is self-determination for someone who is terminally ill.”

Still, Ms. Lee, the author of “Finish Strong: Putting Your Priorities First at Life’s End,” said that there are options for the majority of dying patients who still lack access to an aid-in-dying law. In addition to voluntarily refusing to eat and drink, everyone has the right to create an advance directive that stipulates the medical circumstances under which they would want no further treatment.

For example, people in the early stages of Alzheimer’s disease could specify that when they reach a certain stage — perhaps when they no longer know who they are or recognize close relatives — they do not want to be treated if they develop a life-threatening infection.

Leaving such instructions when a person is still able to give them “is a gift to the family, relieving loved ones of uncertainty,” Ms. Lee said. She suggested consulting the website compassionandchoices.org for tools that can help families who want to plan ahead.

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Getting a Prescription to Die Remains Tricky Even as Aid-in-Dying Bills Gain Momentum

Those who back the bills say the aid is morally wrong while opponents say criminalizing the practice would be a backstep for patients’ rights.

Valium, also known by the name diazepam, is one drug used in a mixture of aid-in-dying medications.

By Katheryn Houghton

KEY TAKEAWAYS

Every session of the biennial Montana state legislature since then, a lawmaker has proposed a bill to formally criminalize physician-assisted death.

Those who back the bills say the aid is morally wrong while opponents say criminalizing the practice would be a backstep for patients’ rights.

But so far, lawmakers haven’t gained enough support to pass any legislation on the issue, though it has been close. The latest effort stalled on March 1, on a split vote.

Linda Heim knew her dad didn’t plan to wait for the cancer to kill him. For decades, he’d lived in Montana, which they’d thought was one of the few places where terminally ill people could get a prescription to end their life.

After two years of being sick, Heim’s dad got the diagnosis in 2019: stage 4 kidney cancer. His physician offered treatments that might extend his life by months. Instead, the 81-year-old asked the doctor for help dying. Heim said her parents left the appointment in their hometown of Billings with two takeaways: The legality of medically assisted death was questionable in Montana, and her father’s physician didn’t seem willing to risk his career to put that question to the test.

“My parents knew when they left there that was the end of that conversation,” said Heim, now 54. “My dad was upset and mad.”

The day after the appointment, Heim’s mother went grocery shopping. While she was gone, Heim’s dad went to the backyard and fatally shot himself. (Heim asked that her father’s name not be published due to the lingering stigma of suicide.)

About a decade earlier, in 2009, the Montana Supreme Court had, in theory, cracked open the door to sanctioned medically assisted death. The court ruled physicians could use a dying patient’s consent as a defense if charged with homicide for prescribing life-ending medication.

However, the ruling sidestepped whether terminally ill patients have a constitutional right to that aid. Whether that case made aid in dying legal in Montana has been debated ever since. “There is just no right to medical aid in dying in Montana, at least no right a patient can rely on, like in the other states,” said former state Supreme Court Justice Jim Nelson. “Every time a physician does it, the physician rolls the dice.”

Every session of the biennial Montana state legislature since then, a lawmaker has proposed a bill to formally criminalize physician-assisted death. Those who back the bills say the aid is morally wrong while opponents say criminalizing the practice would be a backstep for patients’ rights. But so far, lawmakers haven’t gained enough support to pass any legislation on the issue, though it has been close. The latest effort stalled on March 1, on a split vote.

Even the terminology to describe the practice is disputed. Some say it’s “suicide” anytime someone intentionally ends their life. Others say it’s “death with dignity” when choosing to expedite a painful end. Such debates have gone on for decades. But Montana remains the sole state stuck in a legal gray zone, even if the practice can still seem taboo in many states with clear laws. Such continued uncertainty makes it especially hard for Montana patients like Heim’s dad and their doctors to navigate what’s allowed.

“Doctors are risk-averse,” said Dr. David Orentlicher, director of the health law program at the University of Nevada-Las Vegas, who helped write clinical aid-in-dying guidelines published in the Journal of Palliative Medicine in 2016. “The fear of being sued or prosecuted is still there.”

Despite that, access to medical aid in dying is gaining momentum across the U.S. Outside Montana, eight states and the District of Columbia allow the life-ending aid — six of them since 2014. So far in 2021, legislators in at least 19 states have pushed aid-in-dying bills, most seeking to legalize the practice and some seeking to drop barriers to existing aid such as expanding which medical professionals can offer it. Many are repeat legalization efforts with some, like in New York, dating as far back as 1995. Only the Montana bill this year specifically sought to criminalize it.

North Dakota considered legislation to legalize medically assisted death for the first time. Rep. Pamela Anderson, a Democrat from Fargo who proposed the measure after hearing from a cancer patient, said she wasn’t surprised when the bill failed in February in a 9-85 vote. The state’s medical association said it was “incompatible with the physician’s role as healer.” Angry voters called Anderson asking why she wanted to kill people.

“But I heard from just as many people that this was a good bill,” Anderson said. “There is momentum to not let this concept go away.”

Back in Montana, now retired state Supreme Court Justice Nelson said he has always regretted joining the majority in the case that allowed the practice because the narrow ruling focused on physicians’ legal defense, not patients’ rights. Having watched a friend die slowly from disease, Nelson, 77, wants the choice himself if ever needed.

Despite — or because of — the court decision, some Montana doctors do today feel that they can accommodate such patient decisions. For example, Dr. Colette Kirchhoff, a hospice and palliative care physician, said until she retired from private practice last year she considered patients’ requests for life-ending drugs.

Physicians who help in such cases follow well-established guidelines set by other states, Kirchhoff said. A patient must have six months or less to live — a fact corroborated by a second physician; can’t be clinically depressed; needs to ask for the aid; and be an adult capable of making healthcare decisions, which is determined by the attending physician. They must also administer the life-ending medication themselves.

“You’re obviously not going to do a case that is vague or nebulous or has family discord,” Kirchhoff said. “The doctors who are prescribing have felt comfortable and that they’re doing the right thing for their patient, alleviating their suffering.” Of her few patients who qualified for a prescription, she said, none actually took the drugs. Kirchhoff noted that, in some cases, getting the prescription seemed to provide comfort to her patients — it was enough knowing they had the option if their illness became unbearable.

For the past six legislative sessions — dating to 2011 — a Montana lawmaker has proposed a bill to clarify that state law doesn’t allow physician-assisted death. Republican Sen. Carl Glimm picked up that effort the past two sessions. Glimm said the current status, based on the more than decade-old court decision, sends a mixed message in a state that the Centers for Disease Control and Prevention ranks as having among the nation’s highest suicide rates. Glimm said allowing someone to end their life because of pain from a terminal illness could normalize suicide for people living with depression, which is also a form of pain.

“It’s really hard because I do sympathize with them,” Glimm said. “What it boils down to is, if you’re going to take your own life, then that’s suicide.”

Kim Callinan, president and CEO of national nonprofit Compassion & Choices, said the comparison to suicide is frustrating. “People who are seeking medical aid in dying want to live, but they are stricken with a life-ending illness,” she said.

Glimm and his bill’s supporters say that some patients could be pressured into it by family members with something to gain, and doctors could prescribe it more often than they should.

But Callinan, whose group advocates for aid in dying, said that since Oregon first legalized it in 1997, no data has shown any merit to the warnings about abuse and coercion. One study showed no evidence of heightened risk of abuse within the practice for vulnerable populations such as the elderly. But critics have said states aren’t doing enough to track the issue.

By now, Leslie Mutchler, 60, knows most of the people on all sides of the debate after years of testifying in support of protecting aid in dying. Her dad, Bob Baxter, was a plaintiff in the case that eventually led to the 2009 Montana Supreme Court decision on medically assisted death. After leukemia whittled his body for years, he died in 2008 without the option, the same day a lower court ruled in his favor.

Mutchler said she didn’t understand how complicated the Supreme Court’s ultimate ruling was until her son TJ was diagnosed with terminal metastatic pancreatic cancer in 2016.

He was 36 and lived in Billings, Montana. By then, the 6-foot-5 man had lost 125 pounds off what had been a 240-pound frame. He couldn’t keep food down and needed a feeding tube for medicine and water. TJ Mutchler wanted to have the choice his grandfather never got. But when he went to his physician and asked for aid in dying, the response was it wasn’t legal. Eventually, Mutchler found a doctor to evaluate her son and write the prescriptions for phenobarbital and amitriptyline. TJ took the drugs more than two months later and died.

“People contact me asking how to find someone and it’s difficult,” Mutchler said. “That’s why people end up taking matters into their own hands.” Research into terminally ill populations is limited, but one national study published in 2019 found the risk of someone with cancer taking their own life is four times higher than the general population.

For Roberta King, another one of Baxter’s daughters, the ongoing fight over aid in dying in Montana means she knows every other winter she’ll make the more than 200-mile round trip from her Missoula home to the state capital. King, 58, has testified against all six bills that sought to ban aid in dying following her dad’s case. She memorized a speech about how her dad became so thin after his medicine stopped working that it hurt for him to sit.

“It’s still terrible, you still have to get up there in front of everybody and they know what you’re going to say because it’s the same people doing the same thing,” King said. But skipping a hearing doesn’t feel like an option. “If something were to happen to this and I didn’t try, I would never forgive myself,” she said.

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3 biggest regrets people have at the end of life

Hospice chaplain shares common regrets she hears from people who have less than six months to live.

By A. Pawlowski

Sitting at the bedside of dying patients, Tenzin Kiyosaki sees every day how regrets can haunt people at the end of life.

The former Buddhist nun works as an interfaith hospice chaplain for Torrance Memorial Medical Center in the South Bay area of Los Angeles, tending to the spiritual and emotional needs of people who have less than six months to live, and listening to their concerns.

When her brother, “Rich Dad Poor Dad” author Robert Kiyosaki, asked her what the dying talk about, she mentioned some of the common concerns she heard over and over. Kiyosaki shares them in her new book, “The Three Regrets: Inspirational Stories and Practical Advice for Love and Forgiveness at Life’s End.”

It’s also a nudge for younger, healthier people to take action to resolve or prevent regrets now.

Kiyosaki wants people to remember that death doesn’t only come to the old.

Remembering that you are going to die is the best way I know to avoid the trap of thinking you have something to lose. You are already naked. There is no reason not to follow your heart. — Steve Jobs

No one knows when their time is up, whether because of an accident or illness.

Life is impermanent not only for you, but your family, friends and loved ones. Kiyosaki’s own mother passed away suddenly at 49, leaving the family in shock.

“Understanding that death can come at any time can help you see how precious life is and how to really get on with our ambitions and our dreams, and to be kind to each other,” Kiyosaki, 72, told TODAY.

“We should clear the regrets now and go for our dreams rather than just hanging on to regrets that take up a lot of mental and emotional space.”

I did not live my life of dreams.

One patient always wanted to travel the world, but never did. “She felt like, ‘I never got out of here, I never got to do what I really wanted to do,’” Kiyosaki said.

For others, the “what if” regrets might center around never taking a chance on starting a business, applying for a dream job abroad or moving to a new city.

Kiyosaki urged people to examine whether they’re neglecting or putting off their dreams and if so, to turn it around and go for them now — it’s not too late. One terminally-ill woman she knew flew to Europe by herself despite all the obstacles in her way.

I did not share my love.

Many end-of-life patients are frustrated that they haven’t been able to share what’s really in their heart and say what they needed to say to their loved ones. For some, that might be “I love you.” For others, just being able to acknowledge, “I was absent, I was cruel, I was unavailable,” can transform a family and allow it to heal.

“I just feel like it’s important for people to see that they don’t have to live their whole life this way,” Kiyosaki said.

“Don’t fade away from life without saying what you need to say,” she writes in her book. “Find ways to say ‘I love you’ and express your love every day.”

I did not forgive.

This is perhaps the biggest regret many people have at the end. Old wounds and unfinished business rise to the surface, but holding on to past grievances hurts us, Kiyosaki writes, citing a quote from Buddha: “Holding on to anger is like grasping a hot coal with the intent of throwing it at someone else — you are the one who gets burned.”

The power of forgiveness is a gift you give to yourself.

Kiyosaki recommends an exercise: Imagine you have one year left to live. Who would you call? What would you do and say to be at peace? Do it now.

“If you just clear the regrets, you have so much more open heart and receptivity to the world,” Kiyosaki said. “Let’s turn it around and enjoy our lives because they are impermanent — we’re all going to face end of life.”

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Should Everyone Have An End-Of-Life Doula?

By Anna Lyons and Louise Winter

On a crisp January morning, we carried Camilla’s purple coffin, covered in blooming yellow flowers, into the Art Deco chapel of a London crematorium as Leonard Cohen sang “Dance Me to the End of Love”. Her family and friends watched from their homes in New York City via a livestream link. They’d recorded voice notes in advance, which we’d uploaded to the music system. Camilla’s coffin rested on the marble catafalque, as their pre-recorded words of love, gratitude and admiration were played. As the curtains closed around her coffin, a recording of Camilla’s niece reading “Phenomenal Woman” by Maya Angelou echoed around the empty crematorium chapel.

Camilla lived a creative, vibrant and full life, surrounded by a wide circle of like-minded people. She died alone on a Covid-19 ward in a central London hospital. In the saddest and loneliest of circumstances, Camilla’s family and friends found a way to come together to say goodbye to the person who had been a huge force in all their lives.an end-of-life doula and a progressive funeral director. Anna supports people who are living with life-limiting illness, their family and friends, helping people to live as good a life as possible right up until the very end. In her doula role, Anna also works with people who are grieving. Louise supports people to put together funerals that honour, heal and inspire. Our joint mission is to normalise death and dying as part of life and living. Over the last year, our work, both together and separately, has changed immeasurably.

Many of us won’t have any idea that, worldwide, in an average year, around 151,600 people die every single day. That’s almost two people every second. Annually, in the UK alone, more than 500,000 people die. However, the Covid-19 pandemic has meant that death and dying have infiltrated and impacted our lives in ways we’ve never experienced before. As a society, we’ve been faced with the shock of horrifying death tolls on a daily basis. We’ve been unable to be at the hospital deathbed of someone we love, or if we were allowed, we’ve had to say goodbye through multiple layers of PPE. Some of us have attended restricted funerals, unable to engage with the rituals and traditions associated with loss

Where do we turn when someone dies? In normal times, we’d seek solace in the presence of others, we’d allow ourselves to be supported by the people around us. They would bear witness to our losses, keeping us close and secure in the knowledge they were near. Devastatingly, Covid-19 has changed all of this. We couldn’t reach out. We couldn’t physically be there. We couldn’t hold someone’s hand as they lay dying in hospital or give a friend or colleague a much-needed hug after a funeral service. Human touch and connection were replaced by a phone, an iPad or a laptop screen – a cold, hard, reflective surface with its ability to “connect” reliant on an intermittent internet connection. With the absence of human connection, of closeness, of the comforting arms of someone we love, how and where did we find consolation and care? How could we find ways to come together while staying apart?

We are privileged that our jobs have allowed us to witness a myriad of inspiring and beautiful ways people have found to do just that. The humanity of NHS staff has astounded us time and again. One nurse stayed with a young woman who was dying alone in hospital long after his shift was over, reading aloud the text messages she was receiving from family and friends. We saw a frightened young woman transferred from the hospital where she was receiving cancer treatment to hospice so she could be surrounded by those who loved her at the end. Her family played her favourite music and soothed her with stories from her childhood in a peaceful room overlooking the hospice gardens. And a newly married man, with his entire life ahead of him, died unexpectedly in a tragic accident. Hospital staff, despite restrictive regulations, rushed to find extra PPE so his new wife could be there to kiss him for the final time.

We watched a fractured community come together to share flowers from their gardens when florists were closed and funeral flowers were unavailable. A simple request via the neighbourhood WhatsApp group resulted in a widow’s doorstep overflowing with blooms for her partner’s coffin. We witnessed how the rules of social distancing have necessitated some radical creative thinking and we worked with a celebrant who designed a long multi-coloured ribbon that everyone at the funeral could touch and hold to feel connected, while still remaining physically distant.

We were asked to help facilitate a worldwide Zoom by a group of friends when one of them died by suicide. They wore his favourite colours, shared photos of the fun they’d had together and raised a glass of champagne in his honour. Separated by a virus, united in grief, connected via technology.

Who would have thought just 18 months ago that today we’d be watching the people we love dying over FaceTime and attending their funerals via video link? Yet the unimaginable has become our everyday reality. And it’s within the reality of the unimaginable that we’ve seen the infinite beauty and endless possibility of the human spirit shine. We’ve learned we can bear the unimaginable. We are bearing the unimaginable. Through kindness, creativity and determination, we’ve found hope in our heartbreak, discovered that our vulnerabilities are also our strengths, and realised that our resilience is born from finding fragments of optimism and wonder in the most unlikely of places

Now, the promise of spring sits in the cool end-of-winter air. Gone are the dark afternoons; the frost and biting wind are slowly disappearing, allowing these March days to tenderly unfurl, reaching expectantly into the longer evening light. They bring with them a degree of anticipation, hope and new life. There is life. There is hope. There’s always hope.

‘We All Know How This Ends: Lessons about Life and Living from Working with Death and Dying’ by Anna Lyons and Louise Winter is available now.

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As death approaches, our dreams offer comfort, reconciliation

As death approaches, relationships can be resurrected, love revived and forgiveness achieved.

By

One of the most devastating elements of the coronavirus pandemic has been the inability to personally care for loved ones who have fallen ill.

Again and again, grieving relatives have testified to how much more devastating their loved one’s death was because they were unable to hold their family member’s hand – to provide a familiar and comforting presence in their final days and hours.

Some had to say their final goodbyes through smartphone screens held by a medical provider. Others resorted to using walkie-talkies or waving through windows.

How does one come to terms with the overwhelming grief and guilt over the thought of a loved one dying alone?

I don’t have an answer to this question. But the work of a hospice doctor named Christopher Kerr – with whom I co-authored the book “Death Is But a Dream: Finding Hope and Meaning at Life’s End” – might offer some consolation.

Unexpected visitors

At the start of his career, Dr. Kerr was tasked – like any and all physicians – with attending to the physical care of his patients. But he soon noticed a phenomenon that seasoned nurses were already accustomed to. As patients approached death, many had dreams and visions of deceased loved ones who came back to comfort them in their final days.

Doctors are typically trained to interpret these occurrences as drug-induced or delusional hallucinations that might warrant more medication or downright sedation.

But after seeing the peace and comfort these end-of-life experiences seemed to bring his patients, Dr. Kerr decided to pause and listen. One day, in 2005, a dying patient named Mary had one such vision: She began moving her arms as if rocking a baby, cooing at her child who had died in infancy decades prior.

To Dr. Kerr, this didn’t seem like cognitive decline. What if, he wondered, patients’ own perceptions at life’s end mattered to their well-being in ways that should not concern just nurses, chaplains and social workers?

What would medical care look like if all physicians stopped and listened, too?

The project begins

So at the sight of dying patients reaching and calling out to their loved ones – many of whom they had not seen, touched or heard for decades – he began collecting and recording testimonies given directly by those who were dying. Over the course of 10 years, he and his research team recorded the end-of-life experiences of 1,400 patients and families.

What he discovered astounded him. Over 80% of his patients – no matter what walk of life, background or age group they came from – had end-of-life experiences that seemed to entail more than just strange dreams. These were vivid, meaningful and transformative. And they always increased in frequency near death.

They included visions of long-lost mothers, fathers and relatives, as well as dead pets come back to comfort their former owners. They were about relationships resurrected, love revived and forgiveness achieved. They often brought reassurance and support, peace and acceptance.

Becoming a dream weaver

I first heard of Dr. Kerr’s research in a barn.

I was busy mucking my horse’s stall. The stables were on Dr. Kerr’s property, so we often discussed his work on the dreams and visions of his dying patients. He told me about his TEDx Talk on the topic, as well as the book project he was working on.

I couldn’t help but be moved by the work of this doctor and scientist. When he disclosed that he was not getting far with the writing, I offered to help. He hesitated at first. I was an English professor who was an expert in taking apart the stories others wrote, not in writing them myself. His agent was concerned that I wouldn’t be able to write in ways that were accessible to the public – something academics are not exactly known for. I persisted, and the rest is history.

It was this collaboration that turned me into a writer.

I was tasked with instilling more humanity into the remarkable medical intervention this scientific research represented, to put a human face on the statistical data that had already been published in medical journals.

The moving stories of Dr. Kerr’s encounters with his patients and their families confirmed how, in the words of the French Renaissance writer Michel de Montaigne, “he who should teach men to die would at the same time teach them to live.”

I learned about Robert, who was losing Barbara, his wife of 60 years, and was assailed by conflicting feelings of guilt, despair and faith. One day, he inexplicably saw her reaching for the baby son they had lost decades ago, in a brief span of lucid dreaming that echoed Mary’s experience years earlier. Robert was struck by his wife’s calm demeanor and blissful smile. It was a moment of pure wholeness, one that transformed their experience of the dying process. Barbara was living her passing as a time of love regained, and seeing her comforted brought Robert some peace in the midst of his irredeemable loss.

For the elderly couples Dr. Kerr cared for, being separated by death after decades of togetherness was simply unfathomable. Joan’s recurring dreams and visions helped mend the deep wound left by her husband’s passing months earlier. She would call out to him at night and point to his presence during the day, including in moments of full and articulate lucidity. For her daughter Lisa, these occurrences grounded her in the knowledge that her parents’ bond was unbreakable. Her mother’s pre-death dreams and visions assisted Lisa in her own journey toward acceptance – a key element of processing loss.

When children are dying, it is often their beloved, deceased pets that make appearances. Thirteen-year-old Jessica, dying of a malignant form of bone-based cancer, started having visions of her former dog, Shadow. His presence reassured her. “I will be fine,” she told Dr. Kerr on one of his last visits.

For many kids, their only experience with death is with family pets, and the return of deceased animals can be comforting.

For Jessica’s mom, Kristen, these visions – and Jessica’s resulting tranquility – helped initiate the process she had been resisting: that of letting go.

Isolated but not alone

The health care system is difficult to change. Nevertheless, Dr. Kerr still hopes to help patients and their loved ones reclaim the dying process from a clinical approach to one that is appreciated as a rich and unique human experience.

Pre-death dreams and visions help fill the void that may otherwise be created by the doubt and fear that death evokes. They help the dying reunite with those they have loved and lost, those who secured them, affirmed them and brought them peace. They heal old wounds, restore dignity, and reclaim love. Knowing about this paradoxical reality helps the bereaved cope with grief as well.

As hospitals and nursing homes continue to remain closed to visitors because of the coronavirus pandemic, it may help to know that the dying rarely speak of being alone. They speak of being loved and put back together.

There is no substitute for being able to hold our loved ones in their last moments, but there may be solace in knowing that they were being held.

Complete Article ↪HERE↩!

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Dying a conscious death

Your dead body might be bad for the environment

By Gabrielle Sturm

As a young and seemingly invincible college student, one presumably does not put much thought into their inevitable death. However, if you are eco-conscious, perhaps it is time to start planning ahead.

The need to preserve one’s lifeless beauty for just a little bit longer has grave consequences for the earth. When a person dies, it is common for their body to be pumped with an embalming fluid that contains a mixture of toxic chemicals in order to postpone their inevitable decomposition. They are then placed in a casket that is likely made up of inorganic hardwood, copper, bronze, and steel. Their toxic body encased in a casket of unsustainable materials will eventually be lowered into the ground in a concrete crypt.

Green burials are a sustainable alternative to this contemporary western burial method. They may also be called “natural burials,” and the process does not involve any inhibition of decomposition. Instead, the body in its natural state is placed into the soil so that it can be recycled into the earth and help to nourish the land, as most decomposing life does. The body is wrapped in a biodegradable shroud or casket and then buried shallow enough to decay in a way that is similar to composting.

Craig Benson, an environmental science and management lecturer, said that the funeral and cemetery industry already appears to be responding to increasing requests for green burials.

“I would like to see more conservation burial options like the Prairie Creek Conservation Cemetery near Gainesville, Florida,” Benson said. “This is where old restoration ecologists, like me, could make a last ditch effort– pun intended– at creating a contiguous savanna habitat and providing lots of underground munchies for the microfauna and microflora. Why have a feast at your funeral when you can be one!”

In the United States, cremation has recently become the most popular choice for those who pass away. While the ashes of our loved ones harbor sentimental value, this way of honoring the dead is unfortunately still harmful to the environment. Cremation leads to release of harmful toxins into the atmosphere, including carbon monoxide, fine soot, sulfur dioxide, heavy metals, and mercury emissions.

When asked about the environmental impact of cremation, Jennifer Kalt, the director of Humboldt Baykeeper, gave insight on the atmospheric consequences of the practice.

“I noticed that the Los Angeles Air Quality Board recently lifted the limits on cremations temporarily due to the number of COVID-19 deaths,” Kalt said. “I’ve read that cremation is a significant source of mercury pollution. Once it’s released into the atmosphere, it gets re-deposited by rain and fog. All that does make me wonder why people think cremation is a better option. My understanding of the green burial concept is that it prohibits embalming, but human bodies still have contaminants that we store up over lifetimes.”

There are a few local options for those who choose to give their body back to the earth. Cemeteries in Loleta, Fortuna, and Blue Lake all offer natural burial options. However, Blue Lake Cemetery is the only place that does not require the body to be contained in a concrete crypt.

Environmental conflict resolution lecturer Natalie Arroyo said that, in her personal opinion, green burials seem like a great end-of-life option for those who would like to practice sustainability even after they die. However, it is important to note that how humans deal with death is wholly intertwined with their cultural, religious, and personal values.

“I would say as a community member and lecturer who has read and heard a little bit about this, that green burials seem like an excellent alternative with environmental benefits,” Arroyo said. “But they may not fit with people’s religious and cultural values, and they may not suit every circumstance. For example, my own father died far away from home, and his body was cremated due to the low cost and need to transport the remains easily over a long distance.”

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Breathing new life into dying

— our moral imperative to reckon with the concept of death

A 16th-century drawing by Hand Baldung Grien depicts a German mercenary speaking with Death. As pandemics swept Europe, stories of hungry and vengeful undead grew in German-speaking lands and may be reflected in burial practices.

By Madeline Hsu

Death is ever-present these days; now, one in three Americans personally knows someone who has died of COVID-19. Before the pandemic, we heard about incidences of mass deaths due to illness in the context of far corners of the globe, safely out of reach. We were insulated from death and could afford to ignore it, sweeping it into a corner of our uneasy minds. Now, death is close to home, and the time is right for dealing with the cultural discomfort it engenders. 

There are multiple problems with the way we view death as a culture, and the pandemic poses an opportunity to evolve in how we think about death and practice death-related rituals. This unique moment is also an apt time to examine our history and try to understand how exactly we came to be this way.

One pressing concern about our death practices is the deleterious effect on the environment that they have.

“You might be surprised at how much environmental damage a person can do after they’re dead,” Erin Blakemore writes for the Smithsonian Magazine.

The prevalent use of embalming chemicals is of chief concern, as pumping these toxic and carcinogenic chemicals into the environment runs the risk of polluting groundwater and harming the living. While certain groups within the U.S. do not embalm, such as those from Orthodox Jewish communities, a disturbing majority of American burials do.

Many of us are relieved about the promise of a reversal in climate policy after watching with horror for four years as the Trump Administration systematically unraveled hard-won environmental protections and regulations. The administration of President Biden has made a commitment to taking ambitious measures to mitigate climate change. With our new commitment to sustainability as a nation, the time is right to consider the environmental impact of the dead and find new, greener solutions.

There are several ways to do this. Of the sustainable burial practices that have emerged in recent years, several stand out as particularly good alternatives to the status quo. One example is the burial pod developed by Capsula Mundi, which uses a corpse’s process of decay to feed a growing tree. This example presents the comforting and poetic idea of creating natural growth, a concept which could perhaps offset the shock of the transition from the casket-and-embalm procedure.

Composting bodies is a concept that has gained momentum recently.

“Within months, your loved one can become soil for your garden,” Molly Glick writes for the Sierra Club. Once placed in a special cylinder that periodically rotates, a corpse is combined with “a blend of fungi, protozoa, and bacteria to accelerate the breakdown of remains.”

The environmental concern brought up by death goes hand-in-hand with a more ideological and existential concern. We go to great lengths and do harm to the environment to embalm and beautify corpses, giving them luxurious boxes that are sealed and prevent degradation of the body. In this way, we deny death. We refuse death and fight it, but what better time is there than in the midst of COVID-19 to reassess our relationship with death? Perhaps this is an opportunity to deal with its environmental repercussions as well as challenge our deep-seated discomfort and rejection of the fact of death in our lives. 

Perhaps a cross-cultural comparison would yield some insights. Many of the inhabitants of our neighbor, Mexico, have historically observed Dia de los Muertos (Day of the Dead), which involves a celebratory rather than funereal attitude and embraces acceptance of death as an undeniable part of the life cycle. Pre-COVID-19, I was fortunate enough to attend a Day of the Dead celebration hosted by the San Francisco Symphony. Marveling at the revelry, I was struck by the positive emotional effect of combining music with costume, color and a sense of joyful spirituality to tackle this taboo topic. Whereas Mexican culture welcomes “spirits” who reunite once a year with the living, our culture fears and abhors the idea of the dead.

The only time we seem to set aside to deal with death as a culture is mainly in jest, at Halloween. We trivialize death and have no meaningful or unifying cultural practice to deal with this most basic and profound of human events, a universal event that touches all lives.

It isn’t completely our fault that we’re so ill equipped to deal with death. We have inherited a discomfort with the topic. It might be worth noting that certain religious views surrounding death help to explain why we’re so steeped in denial. The “life after death” concept crosses cultural and religious boundaries. Like the Egyptian pharaohs, we endeavor to take our worldly possessions with us, including clothing and makeup-enhanced features, as we voyage into the proverbial afterlife in comfy, cushy coffins. This attempt to simulate life-like conditions reflects our pervasive discomfort with the idea of death.

The bottom line is, we have a moral imperative to deal more responsibly with death. It is long overdue and COVID-19 has highlighted this reality. By gaining some comfort with the fact of death and confronting our resistance to dealing with it, perhaps we can gain some confidence about being able to handle the entirety of the life cycle and have some measure of acceptance where before there was only denial.

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