Category: Preparing for Death

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What an End-of-Life Doula Can Do for You

— Sometimes, you need help navigating your grief and the dying process

Death and dying aren’t always easy subjects. Conversations about your end-of-life desires and the legacy you want to leave behind can be particularly difficult for some individuals, as well as their family and friends.

If you’re diagnosed with a terminal illness, understanding how much time you have left and deciding how you’ll spend it can be difficult to navigate. For friends and family members — especially for young ones who’ve never experienced a death in their family — understanding what happens when someone dies can be confusing and challenging.

When we broach the topic of death, we’re forced to confront our own mortality and come to terms with what will happen to our bodies when we die. But when we face the death of a loved one, we’re confronted with a different set of challenges. Sometimes, we’re dealing with an impending death long before it happens. Other times, death happens swiftly and suddenly in the most unexpected ways.

No matter how someone dies, we each find different ways to grieve the loss of a loved one. Sometimes, we have to handle all the logistics around someone’s funerary services. And then, there are all the things left unfinished in the wake of that person’s death — their hobbies, their dreams, their bills and their responsibilities.

While dying can sometimes be a complicated experience, having help along the way to process your grief and understand what’s happening can make the act of dying more manageable. That’s where having an end-of-life doula can help.

Palliative medicine physician David Harris, MD, and end-of-life doula and social worker Anne O’Neill, LSW, CDP, explain how end-of-life doulas work together with palliative care and hospice teams, and exactly what you can expect when hiring an end-of-life doula.

What is a death doula?

Birth doulas and death doulas function like two sides of the same coin. A birth doula is a trained professional that assists someone before, during and after childbirth. They work alongside your healthcare team to provide emotional and physical support, education and guidance to make sure you have a positive birthing experience.

Similarly, a death doula — also known as an end-of-life doula, end-of-life coach, death midwife or death coach — assists a dying person and their loved ones before, during and after death. An end-of-life doula provides emotional and physical support, education about the dying process, preparation for what’s to come and guidance while you’re grieving.

“A doula wants to do as much as they possibly can to help facilitate what the person and their family need,” says O’Neill. “Doulas make sure the threads are connected between the dying person and the important people in their lives, including their hospice team.”

End-of-life doulas aren’t licensed to provide any medical assistance, but they may advocate for the dying person’s wishes and needs while working together with healthcare providers.

“There is value in having an interdisciplinary team, with the idea that different fields have different things they bring to the table,” notes Dr. Harris. “The best way to give great care to someone is to involve different viewpoints, different levels of expertise and different types of expertise. End-of-life doulas and religious leaders both fall into that framework.”

In recent years, as a result of the COVID-19 pandemic and the surge of related deaths worldwide, there’s been an increased interest in hiring end-of-life doulas to help those who were dying and those who were grieving. There’s also been an increased interest in people wanting to become licensed as end-of-life doulas.

“For many people who are approaching the end of life, being prepared and having everything in place for when they do die is a very important thing. They don’t want their families to be scrambling, and they have certain ideas about what they want their funeral to look like,” explains Dr. Harris.

“Usually, in palliative care or hospice, we give them the space and a listening person to help them plan out what they really want. For many, it’s not as much about finding a funeral home or finding resources as it is just a hard thing to talk about.”

And in many ways, the core function of an end-of-life doula is to be present and listen to the needs of the person who’s dying and the needs of those around them who are grieving.

“We don’t die twice. We only get one chance to do this,” says O’Neill. “When you’re bringing in a doula, you’re bringing in a wide range of experience and a real desire to want to be there with that person and to make it as good of an experience as it can be.”

What exactly does an end-of-life doula do?

Each dying person’s needs are unique to their specific situation, but the services offered by an end-of-life doula could include a mix of the following:

  • Providing the opportunity to talk openly and honestly about the dying process.
  • Alleviating the anxiety, guilt and shame often associated with death and dying.
  • Developing a plan for how the person’s environment looks, feels, sounds and smells.
  • Coordinating with family and friends to evaluate visitation.
  • Overseeing 24/7 care alongside healthcare providers like hospice and palliative care.
  • Providing education and guidance related to other medical services like do-not-resuscitate orders and healthcare power of attorneys.
  • Creating guided meditations and rituals specific to a person’s religious faith or spirituality.
  • Sitting vigil with a person as they near their final moments.
  • Assisting with obituaries and planning funeral services.
  • Providing supplemental grief counseling and companionship after someone has died.
  • Finding creative ways to honor the person after they’ve died, which can include the person who’s dying as a part of that process and exploring that person’s life and legacy.

“Our goal is to provide the kind of support people need so that families aren’t exhausted. We want families to have a chance to rest and we want to ensure that people who are dying are not unsafe at home,” O’Neill adds.

Part of that process is making sure the person who’s dying is aware of what’s happening and, if they’re able or they desire it, to give them the space to confront their own grief and be an active participant in their dying process.

“A dying person is grieving their losses, too. They’ll never see their partners again. They’ll never do the things they love again. So, the doula allows a dying person to express their losses,” says O’Neill.

Along the way, an end-of-life doula may help with what’s referred to as “legacy work,” a process O’Neill says is about exploring the most meaningful moments of someone’s life and finding ways to pass on their legacy. Sometimes, this looks like putting together a scrapbook of memories. Other times, it’s about making those phone calls and writing those letters to long-lost friends or siblings and finding closure in other ways.

“Doulas can help facilitate those conversations to make sure they tie up those loose ends and they’re able to say what they want to say before it’s too late,” she explains. “I had one gentleman who always wore flannel shirts his whole life. He and I cut the buttons off of his flannel shirts and made bracelets for his granddaughters so that they would have those to remember him after he died.”

And end-of-life doulas can extend their services to those loved ones who are grieving by providing education and resources along the way. Sometimes, that means a doula may have to call the funeral home to announce the death of the person who died and make an appointment for the funeral. Other times, a doula may just be on standby should the family need their support during the final hours of a person’s life and in the weeks or months after they’ve died.

“Our hearts have to fill back up again after such a loss,” notes O’Neill. “As doulas, we’ve come to know these families, so we are able to give them what support they need afterward. We don’t just close the book and say, ‘On to the next one.’”

What’s the difference between a death doula and hospice?

End-of-life doulas are similar to hospice care in that both offer counseling, spiritual support and other nonmedical services to help a dying person and their loved ones during their final days. The medical piece is what sets hospice care and end-of-life doulas apart because doulas are typically not licensed to provide any hands-on medical assistance. That said, doulas are fast becoming an integrated part of hospice care teams. If your hospice care team doesn’t have an in-house doula, if you decide to hire one, the hospice care team should work with them throughout the dying process.

“An end-of-life doula’s approach to care is very consistent with hospice care and they’re very synergistic,” says Dr. Harris. “Where end-of-life doulas excel seems to be advocating for people who are dying, planning and having some of those crucial conversations.

“The medical piece is just a small part of somebody’s end-of-life experience and we have to acknowledge, as healthcare providers, that sometimes the medical pieces aren’t the most important pieces. Sometimes, it’s connecting, from one human to another.”

What type of training or certification does a death doula have?

There are a variety of accreditations available to those interested in becoming an end-of-life doula. Although there aren’t universally recognized requirements for becoming an end-of-life doula yet, organizations like the International End-Of-Life Doula Association and the National End-Of-Life Doula Alliance offer training and certification requirements that include:

  • Reading required materials.
  • Completing a work-study or class.
  • Participating in a multiday training program or workshop.
  • Obtaining recommendations from healthcare providers and people they’ve assisted.
  • Following a strict code of ethics.

“Individuals and their families are very vulnerable when they’re at the end of their lives, so that ethical piece really needs to be there and needs to be pronounced,” stresses O’Neill.

Should you hire a death doula?

The decision to hire an end-of-life doula is a very personal decision, one that should be discussed with you and your family in the same manner of understanding and respect that any other end-of-life decisions should be discussed.

“It’s not easy being cared for. When you see your doctors, you’re expected to sort of be able to clarify and explain exactly what’s going on physically, emotionally, spiritually. At the same time, you’re not feeling well. So, that’s a really hard thing to do,” states Dr. Harris.

“Having somebody like a death doula who has experience taking care of people at the end of their lives and who has the time to sit and be with that person and help them figure out what’s going on can be really valuable.”

Complete Article ↪HERE↩!

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The toughest conversation

— Talking end of life with patients

By Kristen Fuller, MD

I saw my first code during my third year of medical school. A day later, I called my mom to discuss her last wishes if something tragic were to happen to her.

I did not want her to be that patient on the gurney being violently coded if that was against her wish. It took a few years of coaxing her into having these tough conversations with me, and after enough coercing (and having to deal with a few hair-raising medical issues), she told me exactly what she wanted to do when the time came.

I regularly try to talk about this with patients, even if they give me pushback, as I firmly believe that every person should have the power to make an educated decision on what they want to be done at the end of their life.

Despite our regular proximity to death, many physicians may lack the necessary skills to have direct, detailed conversations about code status, long-term prognosis, quality of life, and end-of-life care.

The last thing we want is for our patients to have to make these very emotional and difficult decisions in the last few months—or even minutes—of their lives. Or for their family members to be forced to guess their loved one’s end-of-life wishes after they’ve become incapacitated. But we can help them prepare for that time—provided we know how to do so.

They don’t teach us about death in medical school

During my medical school and residency, we didn’t spend much time discussing death, having end-of-life conversations with patients and families, how to manage pain or anxiety during the dying process, or the intricate differences between hospice and palliative care.

Nobody taught us how to approach or use advance directives, or when to discuss them with patients. Such terms came up in conversation and during rounds, but there was no teaching method or structured learning objective—or even conversations about them.

We learned how to have end-of-life family meetings while watching senior residents, whose styles and conversational skills were all over the map. Death was not a natural, omnipresent, physiological process but rather the unspoken consequence if we did our jobs wrong—almost like a failure.

Becoming comfortable with death

“Death is a normal part of life. Everyone dies and deserves to die with dignity, with the choice of how they take their last breaths.”
— Kristen Fuller, MD

Luckily, in my final year of residency, I had the privilege (after a lot of kicking and screaming) of taking three important elective rotations: palliative care, hospice, and pain management and rehabilitation.

During these months, I learned how to be comfortable with death and dying, appropriately manage pain in all its different forms, have difficult conversations with patients and families about these topics, and give myself grace and compassion when a patient dies.

These skill sets have tremendously helped me in my professional life—as well as in my personal life, as I am often the one having the difficult conversations on these issues with my family members.

Taking control

A Kaiser Family Foundation study reported that only 56% of adult Americans had a serious conversation about healthcare preferences, 27% wrote down their preferences, and just 11% discussed them with a healthcare professional.[1]

The most powerful thing patients and families can do to take control of their healthcare is to think through what’s most important to them if they become seriously ill. They should also identify a person they trust to represent them if they can’t speak for themselves.

It’s never too early to raise the topic

“I always encourage physicians and family members to ask questions about end-of-life care early on, as it’s never too soon to start talking about it—but there is a point where it may be too late.”
— Kristen Fuller, MD

During office visits, try to discuss code status and advance directives with the patient, and encourage family members to talk about it with each other.

Before asking these questions, you may want to discuss why you’re having this conversation. Perhaps you can offer a professional or personal experience you had with death when a patient or family member didn’t have any decision-making powers.

“I often tell patients about my first experience as a medical school student witnessing a code.”
— Kristen Fuller, MD

Here are some possible conversation starters:

  • What is important in your life? How would you like to be remembered?
  • What experiences have you had so far with death? What do you think death means?
  • What will happen when you die? Do you need to make any plans or choices now?

How to discuss end-of-life care

Choose a quiet, comfortable, private space to meet without interruptions (turn off your electronics). Ask your patient what they know about their condition and its prognosis so you can better understand their knowledge and mindset. The goal is for the patient to lead the conversation and tell you what they want to do.

If there are discrepancies between what you and the patient know about their situation, it’s your job to tell them the truth. Use plain language, speak slowly and clearly, and make sure they can hear and understand you. Then give them a few moments to process this information before asking if they have any questions.

Determine what your patient wants in the last years, months, or weeks of their life. How do they wish to take their last breaths? How would they like to spend their time? Do they want to be coded when their heart stops? Do they want to be readmitted to the hospital if their condition worsens? Would they want palliative or hospice care?

“It’s our job to learn and document the patient’s specific wishes. In doing so, we must be honest and educate the patient on the differences between hospice and palliative care.”
— Kristen Fuller, MD

Focus on realistic goals

An author writing in Family Practice Management provided insight on how to guide patients’ expectations about the end of life.[2]

“Redirecting the patient’s focus from ‘cure’ to a more reasonable goal, such as living long enough to complete certain tasks (healing relationships or witnessing certain events such as a wedding or birth of a grandchild) can be helpful,” the author wrote. “Even a pain-free death could be a goal.”

The author added that “it is possible to have both qualities of life and quantity of life,” as research showed that patients who receive hospice care live longer than those who pursue aggressive treatment.

Complete Article ↪HERE↩!

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Dying can be a taboo topic.

— Enter the death doula.

Laura Lyster-Mensh at Congressional Cemetery with a faux skeleton. She is the cemetery’s resident death doula.

‘It feels as if our culture is very afraid of death, and that’s not good for life,’ said Laura Lyster-Mensh, resident death doula at Congressional Cemetery in D.C.

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A group of people gathered at Congressional Cemetery in D.C. on Saturday morning for an unusual reason: to practice dying.

One by one, participants reclined on a makeshift bed, as Threshold Choir — a local singing group that comforts people near the end of life — serenaded them.

The exercise was led by Laura Lyster-Mensh, Congressional Cemetery’s first-ever “death doula.” On Saturday, she held the inaugural “Death Doula Day” — the first in a series of weekly events at the cemetery to encourage people to talk openly about death.

It’s part of a nationwide death-positive movement — the idea that it’s healthy, rather than taboo, to talk about death and dying. In Mexico, for example, the Day of the Dead is an important tradition of remembering loved ones and “commemorating death as another element of life.”

Threshold Choir volunteers performed “song baths” to emulate the experience of people who are visited by the singing group at the end of their lives. The choir started off with a tune by its founder, Kate Munger, called “You Are Not Alone.”

“The room was spellbound and very moved,” Lyster-Mensh said. “We were all very present.”

For participants like Ariel Casey, it offered solace. She has lost six people in the past two years.

“Three to heart conditions, one to cancer, one to murder and one to simple old age,” said Casey, 42, who lives in Wheaton, Md.

When she saw a notice for “Death Doula Days,” Casey said, “I felt a call.”

The session was comforting, she said, adding that she plans to attend more Death Doula Days in the future.

In her new volunteer position at Congressional Cemetery, Lyster-Mensh is trying to make the subject of mortality more approachable.

“It feels as if our culture is very afraid of death, and that’s not good for life,” she said.

Lyster-Mensh will hold Saturday sessions for activities such as obituary writing and a card game called the Death Deck. There will be speakers, including Rosie Grant, who went viral for making recipes she finds on gravestone epitaphs, and plenty of cake for participants to eat.

“The idea is to come together and have courageous conversations about death, and then also enjoy life,” she said.

Lyster-Mensh became a death doula — which is also referred to as an end-of-life doula — about a year ago. Unlike labor doulas, who focus on childbirth, death doulas aim to ease the daunting dying process for people in their final days, offering emotional, physical and spiritual support. Death doulas do not address medical concerns, and they differ from hospice chaplains, she said, as they are not religious professionals.

“I hold people’s hands,” said Lyster-Mensh, who is also a writer. “That’s mostly what I’m needed for.”

Her decision to become a death doula came after her father and a close friend died in 2014, and in both cases, “they didn’t leave me messages. They didn’t sum things up,” she said.

“That prompted me to think about what people could do to have a good death, and leave things behind the way they would want them to be organized,” Lyster-Mensh said, adding that she believes some people fear death so much, it interferes with their appreciation of life.

Death doulas help people live out their dying days as they choose — whether that’s reflecting on regrets, calling loved ones to say goodbye or simply sitting still.

“I don’t think our job is to change their emotions, it’s to walk alongside them in their emotions, and let them be authentically them,” Lyster-Mensh said.

For dying people who don’t have someone to hear their thoughts at the end of their lives, it can be cathartic and calming to share them, even with a caring stranger.

To become a death doula, Lyster-Mensh took a month-long course, which covered vigil planning, rituals and ceremonies, active listening, signs and symptoms of dying and other death-related topics.

During her training, for instance, Lyster-Mensh learned that although the human instinct is to encourage others to eat and drink, if a dying person refrains from consuming anything, it’s actually “better for the body in a lot of ways,” she said, adding that animals behave similarly when they’re dying. “It’s a natural part of things.”

Similarly, if a dying individual no longer enjoys their favorite music, that’s a normal progression, too. “Music can sound different to people at the end of life,” Lyster-Mensh explained.

Valoria Walker, an end-of-life doula and an educator at the International End-Of-Life Doula Association, was Lyster-Mensh’s instructor — and is now her mentor. Walker taught her students that talking openly about death lessens the discomfort and unease around it, and that clears the way for people to think about their hopes for when it is their time.

“We can’t make informed decisions about anything unless we talk about it,” said Walker, who started a company called Doula by Destiny in 2016.

Last May, Lyster-Mensh began volunteering as a death doula in the hospice unit at Sibley Memorial Hospital. Since then, she has sat at the bedsides of about 100 dying people. While many reminisce about the past, others focus on the present moment.

Some people don’t want to talk at all, she said, and in those cases, she just keeps them company — which might seem insignificant, but her presence serves an important purpose, she said.

“I’ve had some very profound experiences with people and their families in those rooms,” said Lyster-Mensh, who volunteers at the hospice unit one day a week.

As Congressional Cemetery’s new resident death doula, she hopes to share her learnings with others.

At the next Death Doula Day, scheduled for Jan. 14, Lyster-Mensh will invite people to write their own obituaries. It’s supposed to encourage participants to get to know themselves better, and decide if, perhaps, there is something they want to change about their lives while they still can, she said.

“People don’t usually do that; they don’t usually sit down and tell the story of who they are,” she said.

Lyster-Mensh first joined the cemetery community in May 2021, after she and her husband moved to a new home about ten blocks away. She began volunteering as a gardener, and now tends to a plot for a family that died in the early 1900s.

“I fell deeply in love with this place,” she said, adding that she also joined the cemetery book club, among other activities. “I started volunteering for everything they have.”

She noticed there was not a space dedicated to openly discuss death at the cemetery, so she volunteered to fill the void.

Jackie Spainhour, the cemetery’s president, said she was elated.

“We’ve never really gone past the surface level of death conversations,” Spainhour said. “We are still an active burial ground, and there is a need in this area for people to have their questions answered.”

Death Doula Days are in addition to the cemetery’s regularly scheduled “Death Cafes” — which Lyster-Mensh is also leading as informal discussions, rather than planned activities.

Spainhour said she is most looking forward to seeing more people “relax their shoulders, and ease into conversations about death without the fear that is really prevalent today.”

Lyster-Mensh said she is hopeful that her Death Doula Days will encourage people to live richer, more purposeful lives.

“I know it sounds like it’s about death,” Lyster-Mensh said. “But it’s really about life.”

Complete Article ↪HERE↩!

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Why some people with euthanasia drugs do not take the fatal dose

Sue Parker (left), before her death, with her daughter Nicole Lee.

by Stephen Brook

When pharmacists delivered Sue Parker a small safe containing the prescribed substance that would end her life, her spirits changed “100 per cent”.

“She went from being down and depressed and upset … her mood just lifted,” her daughter Nicole Lee said.

“She just smiled instantly and thanked them and wanted champagne for everyone.”

Parker, a nurse who was diagnosed with motor neurone disease, is not the only voluntary assisted dying applicant to get a lift after her application succeeded.

Yet hundreds of people who qualify for the medication have not used it.

In the first three years of the scheme, 1035 people were issued permits for the prescribed medication.

The substance was dispensed to 849 people, but only 604 permit-holders took it.

“Having some control of the dying process may lift psychological and general health,” said Julian Gardner, chairperson of the voluntary assisted dying review board.

“For many people, having access to medication gives them the option to exercise their autonomy and die on their own terms. Some of those people choose not to have the medicine dispensed and some have the medication and choose not to take it. We know from feedback they do receive comfort from that.”

However, for some, the medication comes too late, he said. “By the time they receive the permit and then request the medication to be dispensed they may have died. They have just left it too late in the process.”

After applicants gain approval, they must have the medication dispensed, and the only pharmacy legally allowed to dispense the medicine is at The Alfred hospital.

“You can’t measure the success of the program solely by the number of people who take the medication and die. There are a significant number of people – up to 30 per cent – who receive the medication, and benefit from having control, but don’t use it,” Gardner said.

Parker, from Ballarat, had always expressed a wish to die on the 28th. It was the date that her parents married and had both died.

“From the minute she was diagnosed she knew [from] being a nurse she was able to get the VAD. Unless you ask, you don’t get told,” Lee said.

Nicole Lee sitting in her late mother’s bedroom on Saturday afternoon.
Nicole Lee sitting in her late mother’s bedroom on Saturday afternoon.

The Voluntary Assisted Dying Act, which in June will have operated for four years in Victoria and will be reviewed by Health Minister Mary-Anne Thomas, includes 68 safeguards and requires multiple approvals.

“The process was so long and so stressful, I reckon it took away more of her life,” Lee said.

“Instead of being able to live she had to spend six months applying, with lots of forms and driving all over the state. The stress of thinking that she wouldn’t get it took away more of her life.

“Doctors have this thing that they are here to save lives not end lives.”

But Parker’s GP did the voluntary assisted dying course to help Parker in the application process, which can take weeks in some cases and months in others.

Voluntary assisted dying is also legal in Tasmania, Western Australia, and Queensland and commences at the end of the month in South Australia and in New South Wales in November. It remains illegal in the Northern Territory and the Australian Capital Territory.

Gardner spoke out against the federal law that blocks doctors from discussing voluntary assisted dying on a telehealth appointment. It is illegal to discuss or advise about it by telephone, email or text.

“People at the end of life often have mobility issues. It is causing distress, and we have called for change,” he said.

Gardner said state laws meant that doctors in Victoria and South Australia could not initiate conversations about voluntary assisted dying. And to qualify for the scheme, patients must be a resident in Victoria for 12 months, which he said would be outdated when the process was legal in all states.

Parker, who lived with Lee, waited about six months after her successful application before taking the medicine.

“Her attitude towards the end of [her] life improved. It didn’t help the disease, but she felt relieved that she could die when she wanted to, how she wanted to and where she wanted to. She could die on her own terms,” Lee said.

Parker died on November 28 at home, and after her granddaughter had finished her exams.

“People don’t know what happens once you drink the medicine on your final day. It was so unbelievably peaceful, it was pure bliss,” Lee said.

“She lay there and slowly fell asleep and from there her heart rate slowed down until it stopped. Her passing was so tranquil.

“That is what this medicine does to you, it just puts you to sleep. It is a really nice way to die if you have to die.”

Complete Article ↪HERE↩!

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6 joyful steps for end-of-life planning

— It isn’t just about wills and funerals — it is a reflection of your values, your goals for healthy aging, and the hopes and dreams you have for those you love

By

The new year is a time of fresh starts and beginnings. But it’s also a good time to plan for the end.

Planning for a health crisis and the end of life doesn’t have to be dreary. There is a lot of joy in organizing your final days, knowing that by being prepared, your final act will be one of guidance and support for your family members and other loved ones. End-of-life planning isn’t just about wills and funerals — it’s also a reflection of your values, your goals for healthy aging, and the hopes and dreams you have for those you love.

From experience, I can tell you that death is complicated for those left behind. Advanced health directives are essential — and should be created when you are healthy, not from a hospital bed. Funeral arrangements are costly, and the details — from the type of service to your final resting place (coffin or urn? Burial plot or cremation?) — are dizzying. Your credit cards, bank accounts, utility bills, cellphone accounts and internet passwords can become a huge burden for those who survive you, if you haven’t planned ahead.

Here’s a simple checklist to help you get started.

  1. Create a crisis notebook: For me, choosing a binder where I could gather all my planning documents is what finally got me started. You will need to create additional hard and digital copies once you’ve made some progress. This AARP worksheet will get you started on compiling all the documents — medical, legal, financial and end-of-life — you need. It will take some time, but the worksheet is a great way to keep track of what you have left to do.
  2. Start by writing your advance directive: Go to the AARP website to find the right forms for your state. This step is the one that most benefits you directly and will help your family make medical decisions on your behalf. The website Five Wishes is also a popular resource, with easy-to-follow instructions for creating an advanced directive.
  3. Write a will: Gallup reports that less than half of Americans have a will. Without a will, the laws of the state will decide how your assets are distributed. Services such as Nolo, LegalZoom or Quicken Willmaker can help for a fee.
  4. Make a digital estate plan: This guide from AARP will help you manage utility accounts, credit cards and social media passwords.
  5. Plan your goodbye party: Having attended several funerals, I don’t want my survivors to incur the expense or burden of planning one. And I actually enjoyed researching the options and making goodbye plans for myself with a focus on a greener ending to my life than a traditional funeral and burial. I’ve picked a lovely black birch tree in the Berkshires through Better Place Forests to mark my final resting place.
  6. Add a last letter: VJ Periyakoil, a physician who specializes in geriatrics and palliative care at the Stanford University Medical Center, started the Stanford Letter Project, to give people the tools they need to write to their doctor, friends or family. You’ll find the template and sample letters at med.stanford.edu/letter.

Complete Article ↪HERE↩!

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How Hospices Can Support Families Seeking ‘Green’ Burials

By Holly Vossel

Hospices can assist terminally ill patients and their families who have questions about “green” burial options by connecting them with services like death doulas or by educating staff on those practices.

Interest in natural or green funeral and burial options has been growing year-over-year, according to the National Funeral Directors Association (NFDA). Around 60.5% of respondents in a NFDA 2022 consumer awareness and preferences survey indicated that they would be interested in exploring natural funeral options, a rise from 55.7% in 2021.

Respondents cited cost savings and potential environmental benefits as leading drivers of their interest.

Demand for natural burials also has grown among hospice patients and their families, according to Lee Webster, director of New Hampshire Funeral Resources, Education & Advocacy.

“I’ve definitely seen a growing trend of natural burials really appealing to a lot of people who are on hospice,” Webster told Hospice News. “A lot of people on hospice services want to run the whole spectrum of that holistic care and tend to be more open to the idea. They are finding a different way to do the disposition, recognizing that natural burials are less expensive than the traditional funeral burial or cremation services most of the time.”

Webster has co-founded organizations such as the National End-of-Life Doula Alliance (NEDA), the Conservation Burial Alliance and the Funeral.org partnership. Additionally, she has served in leadership positions at the National Home Funeral Alliance and the Green Burial Council.

Natural burials are another way for families to take care of the dying in “the least invasive way possible,” according to Webster. “Much like hospice, it’s a continuum of creating a seamless transition to death” she said.

Though natural burials represent roughly 5% of all funerals nationwide, nearly three-quarters (72%) of cemetery operators have reported increased demand for these services, according to NFDA.

The global green funeral market reached $571.54 million in 2021 and is anticipated to reach an 8.7% growth rate by 2030, according to 2022 projections from Emergen Research.

As more hospices partner with death doulas, they can leverage those collaborations to help families and staff understand the four pillars that define a natural burial, Webster said. Death doulas also can help hospices connect families with natural burial resources and services.

One pillar is the use of biodegradable materials or containers that are designed to reduce carbon emissions and deforestation associated with traditional caskets made of wood, plastic and cement mixtures.

The other three pillars include the use of natural, noninvasive preservation methods instead of chemical embalming practices; avoiding the use of vaults and completing burials at 3 ½ to 4 feet.

Patients and families seeking these also need to understand state laws and limitations around natural burial methodologies.

Human composting, for example, is only legal in six states, according Lauren Carroll, co-one of the founders of Deathwives, a death doula provider. Additionally, water cremation is only available in 26 states, she added.

Death doulas can help expand hospices’ knowledge around their local natural burial options that they otherwise might not have built into their staff education and training, Carroll said.

“[The] knowledge aspect of understanding that comes from death doulas isn’t something a hospice necessarily has a place for in its staff education,” Carroll told Hospice News. “That education aspect is the biggest part of communicating all these different burial and funeral options to families so they have a better understanding.”

Hospices can help the family by preparing the necessary documentation bereaved families will need to arrange a natural burial, according to Webster.

“Each state has different requirements about when death certificates need to be filed and when families are able to bathe, dress and prepare their loved one for a natural burial,” Webster said. “Another important thing to know is that the hospice is not liable for anything that the family does with the body after they’ve signed that death certificate.”

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Psychedelics for End-of-Life Patients

— What the Research Says

Psychedelics drugs may help dying patients face death. However, practitioners and researchers advise caution. End-of-life is a unique time with a distinct set of risks requiring specialized care. Using psychedelics for patients facing death has yet to be thoroughly tested.

By Sharleen Lucas, RN

  • Psychedelic drugs may help end-of-life patients by opening floodgates of new brain connections, reducing anxiety and feelings of isolation.
  • Research suggests side effects and risks of psychedelics for therapy are low in medically stable subjects.
  • End of life patients, however, face unique circumstance and are not medically stable.
  • Hope surrounds the promise of psychedelic-assisted therapy, but more research with terminally ill patients is needed.
  • In the meantime, there are other ways end-of-life patients can find connection, peace, and meaning.

Using psychedelic drugs (psilocybin, DMT/Ayahuasca, ketamine, MDMA, and LSD) for mental health treatment is a hot topic in current research.

America’s mental health crisis has not abetted, showing a need for innovative treatment. Evidence and confidence are growing around psychedelic use paired with talk therapy.

Mental anguish is common among people with terminal illnesses. As therapy with psychedelics continues to demonstrate emotional healing, more practitioners are eager to use the tool for end-of-life patients.

A powerful therapeutic tool

Psychedelic drugs, also known as magic mushrooms and hallucinogens, affect mood, energy levels, cognition, and perception. For many people, they stimulate profound spiritual experiences, dissolving the feeling of disconnection from self, the world, the universe, and a higher power.

People around the world have used psychedelics for centuries as a cultural and spiritual practice. Today psychedelics in both plant-based and synthetic forms are used recreationally and in scientific studies.

Many therapists, psychologists, and psychiatrists cite dramatic improvements in conditions like anxiety, depression, and post-traumatic stress disorder, lasting for weeks to months.

Science isn’t sure how psychedelics work, but they briefly quiet some parts of the brain and open others, causing a floodgate of new connections. This floodgate releases people from entrenched thought patterns and builds new neurological connections, something known as neuroplasticity.

As a result, many people change their minds and their lives.

These life-changing revelations can arise from disturbing psychedelic trips. Still, many who endure a gut-wrenching hallucinogenic journey say it was one of the top five most important events in their lives – worth the anguish for the rich healing.

Research suggests the best outcomes – long-lasting and life-changing – happen with intense therapy before and after taking a psychedelic drug.

Perhaps the most powerful outcome of using psychedelics for therapy is an increased sense of belonging. Connectedness is a deep, human need regardless of race, ethnicity, and culture. Feeling disconnected causes internal turmoil that can lead to chronic health problems.

Psychedelics for end-of-life care

In the last weeks and months of their lives, people face an intense rollercoaster of emotions, including fear, anxiety, and sadness.

Research has shown that psychedelic therapy can reduce death anxiety and increase a sense of connection and meaning for end-of-life (EOL) patients.

An academic book published in 2022 called Disruptive Psychopharmacology discusses the current science of psychedelic use for therapy and its safety and implementation. Psychiatrists and neuroscientists from John Hopkins and the University of California, San Francisco, collaborated on an end-of-life and palliative care chapter. They reviewed the research on psychedelics for patients facing the last stage of a terminal illness, often cancer.

As the authors noted, research with psychedelics for terminally ill patients started in the 1960s. Since then, research with dying patients continues to be promising – although narrow in scope – for improving depression, fear of death, discouragement, and connectedness.

Relief from fear and isolation are two serious emotional challenges for EOL patients. They seek peace and connection to their loved ones. Psychedelics coupled with therapy could achieve more comfort.

The risks of psychedelics for EOL

However, the psychology community advises caution in using psychedelics for end-of-life patients.

According to Dr. David B. Yaden and his team of researchers who wrote the EOL chapter in Disruptive Psychopharmacology, most researchers have studied psychedelic use with medically stable patients, even if they have a mental illness.

EOL patients are not medically stable and can be highly stressed. Psychedelics may worsen symptoms like insomnia, confusion, delirium, shortness of breath, and diarrhea.

They could also cause patients to question long-held spiritual beliefs, possibly adding more stress to the patient and loved ones.

The authors also said we know too little about whether psychedelics interact safely with medications commonly given to EOL patients.

Furthermore, there are no dosing and treatment protocols, certification processes, or professional organizations to oversee the safe use of psychedelic therapy.

Even worse, there are too many reports of sexual abuse by psychedelic-assisted therapists. Thorough training and vetting of therapists are needed because assisting psychedelic trips is very specialized and challenging for therapists.

In a 2022 Medium article, Dr. Rosalind Watts, a leading researcher on the therapeutic use of psychedelics, wrote that real healing is possible when psychedelics are “interwoven into very intentional therapy…The drug was a catalyst to the therapeutic process, not the therapeutic process itself.” She worries we focus on the drug and not the expertise of therapists.

Palliative care specialists say there are many natural wonders – spiritual and physical – in the dying process. They worry that psychedelics may negatively interrupt a naturally beautiful process that, by itself, can create positive transformation.

Obtaining psychedelics for EOL therapy

Psychedelics are only legally available for research studies, but in the coming years, that will change.

Oregon and Colorado legalized psychedelics for therapeutic use in the United States, while several other states have decriminalized them. Once a drug is legalized or authorized by the FDA, however, implementing their use can still take a few – sometimes several – years.

Other ways to open your mind

Music triggers the brain’s pleasure center and a broad, highly diverse network of brain neurons.

Studies suggest spirituality – like psychedelics – hushes the self-focused parts of the brain. This effect happens in the deepest states of prayer and worship, causing “me” to meld seamlessly into connectedness with others, the universe, and a higher power.

Various forms of meditation also open neurological pathways in transforming ways.

Many studies show that healthy relationships and participation in a diverse community reduce stress and improve a sense of belonging.

If you or a loved one face the end of life, it’s essential to talk with a spiritual advisor or a palliative care specialist who can help you find what works for you to feel connected and unafraid.

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