A 2000-Year-Old Mummified ‘Sleeping Beauty’ Has Been Found Buried With a Mirror

Who was she?

By MICHELLE STARR

Archaeologists in southern Siberia have unearthed a remarkable find – the mummified remains of a woman, carefully adorned in silk and buried with riches. Miraculously, her resting place was unscathed after being underwater for many years.

The team spotted the grave on the bank of the Yenisei River upstream of a giant dam – in a region that had been periodically underwater for decades.

She’s been nicknamed “sleeping beauty”, and was probably buried sometime in around the first century CE, archaeologists from St Petersburg’s Institute for the History of Material Culture believe.

Her burial place is near the Sayano-Shushenskaya Dam, which powers a hydroelectric power plant, and had been underwater for a great deal of time since the 1980s, when the reservoir began to be filled.

But her burial was unusual – she was laid to rest in a stone coffin – which is how her remains managed to survive being flooded.

“The mummy of a young woman was found inside a grave at the burial ground Terezin on the shore of a water reservoir. The lower part of the body is well-preserved,” explained archaeologist Marina Kilunovskaya of the Institute to Russian news agency TASS.

“It is not a classical mummy, though. The grave remained tightly sealed under the stone cover all along. The body underwent natural mummification.”

The waters recede every May and June, which allows archaeologists a short period of time to access the archaeological sites that were covered by the reservoir. They opened the tomb in May this year.

Inside, the burial was exceptionally well preserved. Soft tissues, skin, clothing and even grave goods were all found intact.

And the clothing and grave goods hint that the lady was a nomadic Hun, young and highly regarded by her people, possibly a noble.

“On the mummy are what we believe to be silk clothes, a beaded belt with a jet buckle, apparently with a pattern,” the Institute’s deputy director, Natalya Solovieva, told The Siberian Times.

“Near the head was found a round wooden box covered with birch-bark in which lay a Chinese mirror in a felt case.”

There were also two vessels buried with her, one of which was a typical Hun vase, both containing a funeral meal, and on her chest was a pouch of pine nuts. Ceramic utensils in the grave were typical of Hun burial practices, the archaeologists said.

Accidental mummification is not uncommon.

Ötzi the Iceman‘s body dehydrated, mummified by the ice of the glacier in which it resided for 5,000 years. The Gebelein mummies were naturally mummified by the heat, salinity and dryness of the Egyptian desert.

Bodies have even been found accidentally mummified by their copper grave goods.

Further work will need to be undertaken to determine exactly how the Sleeping Beauty was so well preserved. It’s also expected that analysis of her body and grave goods will reveal a lot about her culture, and her own life in particular.

The artefacts and body have been removed from the grave, and restoration experts have already started work to preserve them for posterity.

Complete Article HERE!

Managing grief with exercise

by Ernie Schramayr

Last month, my parents celebrated their 84th and 88th birthdays. At the same time, they were living with late-stage cancers and seemingly out of treatment options. After managing their diseases for over 15 years, they were fading fast and by the end of the month, both had passed away.

No matter your age or the circumstances, losing a parent is tough. Losing both of your parents in the same month, however, takes grief to a whole new level. I was somewhat prepared for their deaths, but, not really ready to navigate the different stages of grieving that I was about to go through, so I decided to just “keep busy” while the different emotions and physical feelings worked their way through my body and my mind.

One of the things that helped me endure these last few weeks was that I kept moving, sweating and exercising. At a time when it seemed like the world was out of control, going to the gym for a workout or to the trails for a bike ride gave me a sense that I actually did still have control over some things. It also gave me a sense of purpose when I really just felt like going to bed. As a matter of fact, when my sister called me with the news that my dad had passed away, I broke down … and then I worked out. To some it might seem a strange reaction but, to me, it felt comforting. It let me clear my head and gave me the ability to better deal with the actual event. After my workout, I breathed easier and then went home to cry some more and to break the news to the rest of my family.

In the throes of the intense emotions that come with grief, the instinct to isolate and withdraw can be overwhelming. I’ve experienced and given in to those feelings many times over the past month myself. There is no right or wrong way to go through the grieving process, and if being alone feels right, it probably is. There is one thing, however, that does seem to help virtually everyone that is in the process of dealing with emotional pain. That thing is exercise.

Aside from bringing a sense of purpose to your life, exercise triggers “feel good” chemicals in the body that elevate mood and result in increased blood flow, circulation and oxygen uptake. It also helps fight feelings of depression, anxiety, fatigue and even “brain fog,” and has been shown to minimize feelings of physical pain and insomnia and is important in helping to regulate appetite.

Exercising during the grieving process can help one regain motivation for work and other social commitments. While all activity is good and “just getting moving” is the right idea, working out at a high intensity can also move you to consider “What else can I take back?” when trying to get back to your “normal” life.

It goes without saying that I am writing this article based on my own personal experience. Exercising while dealing with intense emotion may not feel right for everyone. The thought of “getting going” might seem overwhelming, but for me it was just what the doctor ordered. Decide for yourself what is the best way forward, but consider the evidence that suggests that engaging in exercise while grieving is one of the best things you can do to make it through the process.

One final thought. While my family and I have been doing well during this trying time, there have been some pretty heavy “moments” and challenging days. I’ve learned to be kind to myself, and if a nap or a slice of pizza or glass of scotch feels right, I’ll skip the gym that day and make plans to pick it up the next. Having a plan and a sense of purpose means that; taking an extra day to mourn won’t turn into a week and then a month and then a year before getting things back on track. In the end, we’re all human and figuring things out as we go to the best of our abilities.

Complete Article HERE!

On death and dying: Do Jews have a choice?

by Martin J. Raffel

There is an old saying, attributed to Benjamin Franklin, that “in this world nothing can be said to be certain, except death and taxes.” Though loathe to get into discussion of the latter, said founding father was obviously correct about the former. At some point, all of us will face an end-of-life situation, and for those of us in New Jersey, the state might soon give us some degree of control over when and how we choose to die.

I refer to the Aid in Dying for the Terminally Ill Act, which is currently pending in the New Jersey state legislature. This legislation would allow physicians to provide life-ending medication to mentally competent patients who are at least 18 and have a terminal illness with a prognosis of, at most, six months to live. The patients must be able to self-administer the medication. Similar measures have passed in California, Montana, Vermont, Colorado, Hawaii, Washington State, and Washington, D.C. — all modeled on Oregon’s Death With Dignity Act enacted in 1997, the first of its kind.

“This option has brought sound public policy and improvements in end-of-life care to the states where it is permitted medical practice, and the time is now to bring the same quality of care to the people of New Jersey,” said Corinne Carey, N.J. campaign director of Compassion and Choices of New Jersey, Inc., the nonprofit, educational organization leading advocacy efforts. Sixty-three percent of the state’s residents support the measure, according to Carey.

I wondered whether there was a Jewish approach to what is sometimes referred to as physician-aided suicide. Not surprisingly, it depends on whom you ask.

I spoke with David Glicksman, an Orthodox rabbi with long-time pulpit and chaplaincy experience who currently serves on the Joint Chaplaincy Commission of the Jewish Federation of Greater MetroWest NJ. While he empathizes with the suffering of families, Glicksman said that because halacha (Jewish law) — which sees human life as sacred, clearly forbids suicide or assisting in suicide— he would oppose the pending legislation.

That said, “passive euthanasia,” the withholding of life-extending measures, as opposed to taking affirmative steps to end a life, is not necessarily a halachic violation. For example, he said, while actively removing a feeding tube or respirator would be unacceptable, one might not be required to replace a tube once it is removed.

But “if a patient asked me whether Jewish law permitted him or her to intentionally starve to death to end their suffering, I would have to answer in the negative.” Still, Glicksman said, he would “without judgment…comfort that patient as part of my pastoral responsibilities.”

On the other hand, Richard Address, a Reform rabbi and the director of Sacred Jewish Aging — a forum that promotes discussion about the revolution in longevity for baby boomers and their families — supports the legislation. “As a non-Orthodox rabbi, I view halacha as an evolutionary process, not rooted in an act of divine revelation,” he said. “Its genius is that it is a product of the social, political, economic, and religious context of the day.”

Address understands the portion of the verse in Deuteronomy 30:19 which states, “You shall choose life, so that you and your offspring will live,” to mean that “the ultimate decision of when to end life rests with me.” This is not a spur-of-the-moment decision, he said. “It’s a product of a lifetime and is driven by three factors: autonomy, the relationship with self; the impact of life-extending medical technology on quality of life; and one’s own spiritual beliefs.”

I speculated, and Address agreed, that it’s the baby boomer generation driving the momentum behind more liberal aid-in-dying laws. This is the generation that brought American society the sexual revolution and women’s liberation. Now that our parents’ generation is rapidly passing into history, we boomers have reached the ‘on deck’ circle and we’re aiming to change the culture on death and dying.

Rabbi Marc Kline of Monmouth Reform Temple — citing the 14th-century Catalonian Talmud scholar Rabbeinu Nissim, and Jewish bioethicist J. David Bleich — said, like Glicksman, that Jewish law prohibits taking active steps to hasten death. But their teachings, Kline said, support the option of praying for death as relief from an unbearable situation.

Stephanie Dickstein, speaking from experience — the Highland Park resident and Conservative rabbi works with older adults and end-of-life and bereavement issues — said, “It is not routine for families to be given emotional or practical preparation for the realities of caring for a loved one whose illness is reaching a terminal stage far enough in advance.” She does not believe the only choice is either using medical technology to extend life at all costs or allowing doctors to end life. “We can have policies and practices which make it the norm to support quality of life and comfort in the final chapter of life, rather than actively involving physicians in prescribing substances to end life.”

I also spoke with Jeff Feldman, advocacy coordinator of the North Brunswick-based New Jersey chapter of the National Association of Social Workers. His organization endorses the legislation, he told me, because “as a profession, social workers believe strongly in the value of self-determination for our clients. An individual with a terminal illness should be able to choose the time and method of their passing, rather than being placed at the mercy of their illness.” Social workers, he explained, often are the professionals with clients and their families during emotional end-of-life situations. “Hospice and palliative-care social workers…are called upon to non-judgmentally lay out for the client all of the available options,” and from his perspective, the more options available to the client, the better.

Just where do I stand? I’m with Address and the social workers in support of the pending legislation. Obviously, I agree with Dickstein that we should have a more effective palliative care system. But at the same time, not seeing myself as bound by a strict interpretation of halacha, I want a greater variety of end-of-life choices. That’s on a personal level.

On a societal level, I don’t think those whose religious or ethical beliefs regard the ending of life as immoral regardless of the circumstances should dictate our public policy.

No one likes to have these discussions, but, inevitably, such difficult medical and ethical decisions still have to be made. Whether you support or oppose this legislation, we all would be well served to thoroughly explore these issues not only with our loved ones, but in appropriate communal forums, as well.

Complete Article HERE!

Mindfulness And Meditation Can Make Your Final Days More Bearable

By Cassie Steele

Death is a one-way journey into the unknown and, as with any other journey you may have undertaken, it will go smoother if you are prepared as can be.  Being somewhat wary of death is natural with even the most spiritual and religious people being saddened at the thought of both their own deaths and the deaths of those they love. The reason death is not generally welcomed with open arms is that, after centuries of trying to understand it, it still remains a great unknown to most of us.  This is where mindfulness can be of most benefit – when the uncertainty surrounding death is strongest. By becoming mindful you will likely find yourself not only being more at peace with your situation but able to find joy and happiness in your surroundings even in the final days leading up to your passing. It will also enable you to view death as the inescapable yet strangely beautiful part of life that it is.

Mindfulness may help you to get comfortable with death

The emotional and spiritual acceptance of your own mortality is the greatest gift you can give yourself. Although dwelling on death continuously isn’t healthy, mindfulness can be very effective in reducing the tremendous anxiety we often experience when nearing our time of death.  Being mindful of your own death entails you coming to terms with your fate, facing your fears head-on and acknowledging your feelings. As difficult as it may seem, it is important to be at ease with all your varied thoughts regardless of how warped they may seem.

While it is near impossible to eradicate all the suffering involved in dying, it is possible to create a place to positively deal with anger, grief, and denial.  Once you become accustomed to practicing mindfulness you will find yourself feeling a lot calmer and ready to live your remaining life to the fullest. In his novella ‘The Canterville Ghost’ Oscar Wilde wrote: “Death must be so beautiful. To lie in the soft brown earth, with the grasses waving above one’s head, and listen to silence. To have no yesterday, and no to-morrow. To forget time, to forget life, to be at peace.” Once you become mindful of your own death, this is how you can perceive their own death as well.

Alleviate your discomfort

Apart from conventional medication and pain-relief strategies, there are a number of holistic approaches that can be employed to alleviate discomfort.  Adapting to a sensory experience helps to nurture joy and mindfulness. We are capable of reducing the physical pain we experience when we focus all our attention on what we see, smell, hear, taste or feel.  Although this may seem slightly far-fetched, the phenomenon has been documented in a range of scientific studies which includes ground-breaking research by American professor emeritus of medicine Jon Kabat-Zinn. The research showed that stress reduction based on mindfulness can drastically reduce pain as well as the depression and anxiety associated with coming to terms with your impending death. Once again take comfort in knowing that death is as natural a part of life as breathing is, and it is, in essence, nothing to fear.

Make your last days meaningful

We often hear people proclaim that we need to ‘live every day like it is your last’ and to ‘make every second count’ and that is exactly what you need to do as you near the end of your life. You have, after all, only been granted with a single shot at life and the least you can do is to make it as memorable as possible. By being mindful and practicing meditation, you can ensure that you get as much out of a day as is humanly possible. Be careful not to limit your mindfulness and apply it in all aspects of your life. You can even be mindful when eating, paying close attention to the entire process. Appreciate the smell and sight of your food, how it feels when you bring the fork or spoon closer to your mouth and how the food tastes. The same process can be applied to anything from sitting on your porch overlooking the garden to having a relaxing bath. Engaging in simple yet effective daily meditations that focus on breathing and pain reduction can help make someone’s final days substantially easier to endure.

Regardless of your spiritual or religious orientation, you are bound to benefit from engaging in end-of-life mindfulness and meditation. There is no rule book with regards to being mindful – by simply following basic guidelines and applying them to the areas of your life that will benefit the most from it, you will reap the countless rewards that being aware holds. Find solace in knowing that death is merely another journey you are about to undertake and one that you have the option of embracing with the same joy and vigor as you did life.

 

5 Life Lessons From End-of-Life Experts

Make sure to do these things while you are still able

By Lisa Fields

You’ve heard it countless times: Life is short, so appreciate each moment.

People with life-limiting diagnoses know this intimately: When they come to terms with their mortality, their priorities often change, and they may try to squeeze as much substance into their lives as they can. This often involves trying to resolve long-standing problems with loved ones and strengthening important relationships.

Very few healthy people live this way, though. We get caught up in the details of our busy lives and often forget to put things in perspective, believing that we’ll have time to sort everything out. But end-of-life experts believe that everyone should adopt some of the attitudes and values that dying patients embrace.

“It’s easy to put something off into the future,” says John Mastrojohn III, chief operating officer of the National Hospice and Palliative Care Organization. “For some, that future may not be as long as we’d like. Having meaningful conversations, or doing other things that bring joy, can have a profound impact on how we feel about ourselves and others.”

You may be inclined to delay these types of conversations if you don’t sense an imminent need. But they can positively impact your relationships and help you realize what’s most important.

“Those of us who work with people who are seriously ill have found that [saying] ‘Please forgive me,’ ‘I forgive you,’ ‘Thank you’ and ‘I love you’ — that almost always has value to people, whether relationships are fractured or strong,” says Dr. Ira Byock, a palliative care physician in Torrance, Calif., and author of The Four Things That Matter Most.

End-of-life experts believe that the following advice — which they often share with patients who are in the final weeks or months of their lives — is surprisingly well-suited for active, healthy people, too:

1. Adjust Your Priorities

You may take your friends and relatives for granted because you’re focused on a work project, your upcoming kitchen renovation or the number of “likes” that you received on a Facebook post. But it’s important to periodically stop to appreciate the meaningful relationships in your life.

“The things that matter most to people aren’t things; they’re other people,” Byock says. “Ask somebody who’s facing cancer or chemotherapy for the third or fourth time what matters, and the answer they give will always include the names of people they love.”

2. Make Time for Loved Ones

Your schedule may make it difficult to see friends or relatives as often as you’d like, but you can change that. Giving priority to your most important relationships should make you feel less frazzled and more grounded.

“There is not a single seriously ill patient I know that worries about all the current items populating their calendar when they receive a life-threatening diagnosis — their thoughts go immediately to their time with those they love,” says Dr. Cory Ingram, a palliative-care physician at the Mayo Clinic in Rochester, Minn. “There are some things in life to postpone; however, relationships with those who matter aren’t on that list.”

3. Have Meaningful Conversations

Most people don’t apologize, seek forgiveness, offer gratitude or extend feelings of love to their closest friends and family members on a regular basis. They may believe that their feelings are tacitly understood by their loved ones. Or they may feel that the topics are too significant to broach in everyday conversation, so they keep their feelings inside.

But putting words to your feelings can boost your relationships significantly. It’s particularly important for parents who may not have shared their thoughts with their children — especially adult children.

“It’s worth taking the time to sit with each of your children and let them know how proud you are to be their mom or dad,” Byock says. “[Or tell them] ‘I love you more than I can say.’ Who else on this planet can give that gift in your voice? I’ve counseled many children who were crying after the death of a parent, who never heard words of that nature. Some of those children were in their 60s.”

4. Don’t Hesitate to Share Deep Feelings

In many families, people don’t discuss emotions unless there’s a crisis, but you can work to change that. Consider how you’d feel if you or a loved one died suddenly, before you had the chance to share what was in your heart. Revealing your feelings can help to alleviate that sentiment and bring you closer.

“Some people say, ‘My kids know that I love them,’” Byock says. “’I say, ‘Great! Then it will be easy for you to say it.’ No excuses and no mumbling.”

It can be particularly difficult for some men to talk about their feelings, especially if they’ve maintained a gruff, stoic reputation. But once they open up, their words can deeply move the people in their lives.

“Most of them aren’t so tough — they just learned to cloak their feelings in a hard shell,” Byock says. “We guys aren’t as verbal about our emotions. We have emotions. We just don’t talk about them. Talking about this stuff can be very impactful.”

5. Prepare for the Worst

Many terminally ill people create advance directives, which are documents that name a loved one to make medical decisions on their behalf in case they are ever unable to speak for themselves.

But two-thirds of healthy people don’t have advance directives, perhaps because it requires them to consider their own mortality. Advance directives are invaluable for everyone, however, since we never know what may happen.

“It’s a way of taking care of your family,” Byock says. “I have an advance directive. Not because I have a serious illness, but because I have a family. I’m a dad, and if I’m in a car accident or have a stroke, if my wife and daughters would struggle, I can give one of them clear authority to speak for me, with no ambiguity. I can give them some sense of what I think I want, to lift a little bit off their shoulders.”

After you designate someone to speak on your behalf, let them know.

“Completing the document is only part of the requirement,” Ingram says. “The real work of completing an advance directive is having a conversation about your values, preferences and priorities for health care with those you named.”

Complete Article HERE!

Does palliative sedation ease suffering during end-of-life care?

By

oward the end, the pain had practically driven Elizabeth Martin mad.

By then, the cancer had spread everywhere, from her colon to her spine, her liver, her adrenal glands and one of her lungs. Eventually, it penetrated her brain. No medication made the pain bearable. A woman who had been generous and good-humored turned into someone hardly recognizable to her loving family: paranoid, snarling, violent.

Sometimes, she would flee into the California night in her bedclothes, “as if she were trying to outrun the pain,” her older sister Anita Freeman recalled.

Martin fantasized about having her sister drive her into the mountains and leave her with the liquid morphine drops she had surreptitiously collected over three months — medicine that didn’t relieve her pain but might be enough to kill her if she took it all at once. Freeman couldn’t bring herself to do it, fearing the legal consequences and the possibility that her sister would survive and end up in even worse shape.

California’s aid-in-dying law, authorizing doctors to prescribe lethal drugs to certain terminally ill patients, was still two years from going into effect in 2016. But Martin did have one alternative to the agonizing death she feared: palliative sedation.

Under palliative sedation, a doctor gives a terminally ill patient enough sedatives to induce unconsciousness. The goal is to reduce or eliminate suffering, but in many cases the patient dies without regaining consciousness.

The medical staff at the Long Beach acute care center where Martin was a patient gave her phenobarbital. Once they calibrated the dosage properly, she never woke up again. She died within a week, not the one or two months her doctors had predicted before the sedation. She was 66.

“At least she got into that coma state versus four to eight weeks of torture,” Freeman said.

While aid-in-dying, or “death with dignity,” is now legal in seven states and Washington, D.C., medically assisted suicide retains tough opposition. Palliative sedation, though, has been administered since the hospice care movement began in the 1960s and is legal everywhere.

Doctors in Catholic hospitals practice palliative sedation even though the Catholic Church opposes aid-in-dying. According to the U.S. Conference of Catholic Bishops, the church believes that “patients should be kept as free of pain as possible so that they may die comfortably and with dignity.”

Since there are no laws barring palliative sedation, the dilemma facing doctors who use it is moral rather than legal, said Timothy Quill, who teaches psychiatry, bioethics and palliative care medicine at the University of Rochester Medical Center in New York.

Some doctors are hesitant about using it “because it brings them right up to the edge of euthanasia,” Quill said.

But Quill believes that any doctor who treats terminally ill patients has an obligation to consider palliative sedation. “If you are going to practice palliative care, you have to practice some sedation because of the overwhelming physical suffering of some patients under your charge.”

Doctors wrestle with what constitutes unbearable suffering, and at what point palliative sedation is appropriate — if ever. Policies vary from one hospital to another, one hospice to another, and one palliative care practice to another.

Not Euthanasia

The boundary between aid-in-dying and palliative sedation “is fuzzy, gray and conflated,” said David Grube, a national medical director at the advocacy group Compassion and Choices. In both cases, the goal is to relieve suffering.

But many doctors who use palliative sedation say the bright line that distinguishes palliative sedation from euthanasia, including aid-in-dying, is intent.

“There are people who believe they are the same. I am not one of them,” said Thomas Strouse, a psychiatrist and specialist in palliative care medicine at the UCLA Medical Center. “The goal of aid-in-dying is to be dead; that is the patient’s goal. The goal in palliative sedation is to manage intractable symptoms, maybe through reduction of consciousness or complete unconsciousness.”

Other groups such as the National Hospice and Palliative Care Organization, which advocates for quality end-of-life care, recommend that providers use as little medication as needed to achieve “the minimum level of consciousness reduction necessary” to make symptoms tolerable.

Sometimes that means a light unconsciousness, in which the patient may still be somewhat aware of the presence of others. On other occasions it might mean a deep unconsciousness, not unlike a coma. In some cases, the palliative sedation is limited; in others it continues until death.

Whether palliative sedation hastens death remains an open question. Pain-management doctors say sedation slows breathing and lowers blood pressure and heart rates to potentially dangerous levels.

In the vast majority of cases, it is accompanied by the cessation of food, drink and antibiotics, which can precipitate death. But palliative sedation is also administered when the underlying disease has made death imminent.

“Some patients are super sick,” Quill said. “The wheels are coming off, they’re delirious, out of their minds.”

In that circumstance, palliative sedation doesn’t accelerate death, he said. “For other patients who are not actively dying, it might hasten death to some extent, bringing it on in hours rather than days.” He emphasized, however, that in all cases the goal isn’t death but relief from suffering.

One review of studies on palliative sedation concluded that it “does not seem to have any detrimental effect on survival of patients with terminal cancer.” But even that 30-year survey acknowledged that, without randomized control trials, it’s impossible to be definitive.

‘Existential Suffering’

There is widespread agreement that palliative sedation is appropriate for intractable physical pain, extreme nausea and vomiting when other treatments have failed.

Doctors are divided about whether palliative sedation is appropriate for alleviating suffering that is not physiological, what medical journals refer to as “existential suffering.” The hospice and palliative care group defines it as “suffering that arises from a loss or interruption of meaning, purpose, or hope in life.”

Some argue that such suffering is every bit as agonizing as physical suffering. Existential suffering is the motivation that prompts many to seek aid-in-dying.

Terminally ill patients who took their own lives under Oregon’s aid-in-dying law were far less likely to cite physical pain than psychosocial reasons such as loss of autonomy, loss of dignity or being a burden on loved ones.

Using palliative sedation to relieve existential suffering is less common in the United States than it is in other Western countries, according to UCLA’s Strouse and other American practitioners. “I am not comfortable with supplying palliative sedation for existential suffering,” Strouse said. “I’ve never done that and probably wouldn’t.”

In states where aid-in-dying is legal, terminally ill patients rarely choose between aid-in-dying and palliative sedation, said Anthony Back, co-director of the University of Washington’s Cambia Palliative Care Center of Excellence. In Washington, patients with a prognosis of six months to live or less must make two verbal requests to their doctor at least 15 days apart and sign a written form. They also must be healthy enough to take the legal drugs themselves.

“If you are starting the death-with-dignity process, you’re not at a point where a doctor would recommend palliative sedation,” Back said. “And with terminal sedation, the patient doesn’t have that kind of time and is too sick to take all those meds orally,” he said of the aid-in-dying drugs.

But Back does tell terminally ill patients who don’t want or don’t qualify for aid-in-dying that, when the time is right and no other treatments alleviate their symptoms, “I would be willing to make sure that you get enough sedation so you won’t be awake and miserable.”

Whether palliative sedation truly ends suffering is not knowable, although doctors perceive indications that it does.

“You might be able to tell if their blood pressure goes up. Same with their pulse,” said Nancy Crumpacker, a retired oncologist in Oregon. “And you read their faces. If they are still bothered somehow, it will show in their facial expression.”

Harlan Seymour didn’t need to rely on those signs after his wife, Jennifer Glass, a well-known San Francisco public relations executive, received palliative sedation in 2015. A nonsmoker, she had metastatic lung cancer and faced a miserable death from suffocation brought on by fluids filling her lungs, her husband said.

She desperately wanted to die, he said, but aid-in-dying, which she advocated for, wasn’t yet legal. Instead, she received palliative sedation.

“The expectation was this cocktail would put her into a peaceful sleep and she would pass away” within a day or two, Seymour said. “Instead, she woke up the third night in a panic.”

Doctors upped her dosage, putting her into a deep unconsciousness. Still, she didn’t die until the seventh day. She was 52. Seymour wishes aid-in-dying had been available for his wife, but he did regard palliative sedation as a mercy for her.

“Palliative sedation is slow-motion aid-in-dying,” he said. “It was better than being awake and suffocating, but it wasn’t a good alternative.”

Complete Article HERE!

Palliative Sedation, an End-of-Life Practice That Is Legal Everywhere

Jennifer Glass, a well-known San Francisco public relations executive, asked her husband, Harlan Seymour, to photograph her every day after her lung cancer diagnosis. Glass, an aid-in-dying advocate, died under palliative sedation in 2015, a year before a new California law allowing medically assisted suicide took effect.

Toward the end, the pain had practically driven Elizabeth Martin mad.

By then, the cancer had spread everywhere, from her colon to her spine, her liver, her adrenal glands and one of her lungs. Eventually, it penetrated her brain. No medication made the pain bearable. A woman who had been generous and good-humored turned into someone hardly recognizable to her loving family: paranoid, snarling, violent.

Sometimes, she would flee into the California night in her bedclothes, “as if she were trying to outrun the pain,” her older sister Anita Freeman recalled.

Martin fantasized about having her sister drive her into the mountains and leave her with the liquid morphine drops she had surreptitiously collected over three months — medicine that didn’t relieve her pain but might be enough to kill her if she took it all at once. Freeman couldn’t bring herself to do it, fearing the legal consequences and the possibility that her sister would survive and end up in even worse shape.

California’s aid-in-dying law, authorizing doctors to prescribe lethal drugs to certain terminally ill patients, was still two years from going into effect in 2016. But Martin did have one alternative to the agonizing death she feared: palliative sedation.

Under palliative sedation, a doctor gives a terminally ill patient enough sedatives to induce unconsciousness. The goal is to reduce or eliminate suffering, but in many cases the patient dies without regaining consciousness.

The medical staff at the Long Beach acute care center where Martin was a patient gave her phenobarbital. Once they calibrated the dosage properly, she never woke up again. She died within a week, not the one or two months her doctors had predicted before the sedation. She was 66.

“At least she got into that coma state versus four to eight weeks of torture,” Freeman said.

While aid-in-dying, or “death with dignity,” is now legal in seven states and Washington, D.C., medically assisted suicide retains tough opposition. Palliative sedation, though, has been administered since the hospice care movement began in the 1960s and is legal everywhere.

Doctors in Catholic hospitals practice palliative sedation even though the Catholic Church opposes aid-in-dying. According to the U.S. Conference of Catholic Bishops, the church believes that “patients should be kept as free of pain as possible so that they may die comfortably and with dignity.”

Since there are no laws barring palliative sedation, the dilemma facing doctors who use it is moral rather than legal, said Timothy Quill, who teaches psychiatry, bioethics and palliative care medicine at the University of Rochester Medical Center in New York.

Some doctors are hesitant about using it “because it brings them right up to the edge of euthanasia,” Quill said.

But Quill believes that any doctor who treats terminally ill patients has an obligation to consider palliative sedation. “If you are going to practice palliative care, you have to practice some sedation because of the overwhelming physical suffering of some patients under your charge.”

Doctors wrestle with what constitutes unbearable suffering, and at what point palliative sedation is appropriate — if ever. Policies vary from one hospital to another, one hospice to another, and one palliative care practice to another.

Not Euthanasia

The boundary between aid-in-dying and palliative sedation “is fuzzy, gray and conflated,” said David Grube, a national medical director at the advocacy group Compassion and Choices. In both cases, the goal is to relieve suffering.

But many doctors who use palliative sedation say the bright line that distinguishes palliative sedation from euthanasia, including aid-in-dying, is intent.

“There are people who believe they are the same. I am not one of them,” said Thomas Strouse, a psychiatrist and specialist in palliative care medicine at the UCLA Medical Center. “The goal of aid-in-dying is to be dead; that is the patient’s goal. The goal in palliative sedation is to manage intractable symptoms, maybe through reduction of consciousness or complete unconsciousness.”

Other groups such as the National Hospice and Palliative Care Organization, which advocates for quality end-of-life care, recommend that providers use as little medication as needed to achieve “the minimum level of consciousness reduction necessary” to make symptoms tolerable.

Sometimes that means a light unconsciousness, in which the patient may still be somewhat aware of the presence of others. On other occasions it might mean a deep unconsciousness, not unlike a coma. In some cases, the palliative sedation is limited; in others it continues until death.

Whether palliative sedation hastens death remains an open question. Pain-management doctors say sedation slows breathing and lowers blood pressure and heart rates to potentially dangerous levels.

In the vast majority of cases, it is accompanied by the cessation of food, drink and antibiotics, which can precipitate death. But palliative sedation is also administered when the underlying disease has made death imminent.

“Some patients are super sick,” Quill said. “The wheels are coming off, they’re delirious, out of their minds.”

In that circumstance, palliative sedation doesn’t accelerate death, he said. “For other patients who are not actively dying, it might hasten death to some extent, bringing it on in hours rather than days.” He emphasized, however, that in all cases the goal isn’t death but relief from suffering.

One review of studies on palliative sedation concluded that it “does not seem to have any detrimental effect on survival of patients with terminal cancer.” But even that 30-year survey acknowledged that, without randomized control trials, it’s impossible to be definitive.

‘Existential Suffering’

There is widespread agreement that palliative sedation is appropriate for intractable physical pain, extreme nausea and vomiting when other treatments have failed.

Doctors are divided about whether palliative sedation is appropriate for alleviating suffering that is not physiological, what medical journals refer to as “existential suffering.” The hospice and palliative care group defines it as “suffering that arises from a loss or interruption of meaning, purpose, or hope in life.”

Some argue that such suffering is every bit as agonizing as physical suffering. Existential suffering is the motivation that prompts many to seek aid-in-dying.

Terminally ill patients who took their own lives under Oregon’s aid-in-dying law were far less likely to cite physical pain than psychosocial reasons such as loss of autonomy, loss of dignity or being a burden on loved ones.

Using palliative sedation to relieve existential suffering is less common in the United States than it is in other Western countries, according to UCLA’s Strouse and other American practitioners. “I am not comfortable with supplying palliative sedation for existential suffering,” Strouse said. “I’ve never done that and probably wouldn’t.”

Elizabeth Martin, standing between her cousin Tamra Halfacre, left, and sister Anita Freeman. Martin, who had colon cancer, died in 2014 under palliative sedation administered to relieve intractable pain. While aid-in-dying is legal in seven states and Washington, D.C., palliative sedation, in which terminally ill patients are rendered unconscious to relieve intractable suffering, is legal everywhere in the United States.

In states where aid-in-dying is legal, terminally ill patients rarely choose between aid-in-dying and palliative sedation, said Anthony Back, co-director of the University of Washington’s Cambia Palliative Care Center of Excellence. In Washington, patients with a prognosis of six months to live or less must make two verbal requests to their doctor at least 15 days apart and sign a written form. They also must be healthy enough to take the legal drugs themselves.

“If you are starting the death-with-dignity process, you’re not at a point where a doctor would recommend palliative sedation,” Back said. “And with terminal sedation, the patient doesn’t have that kind of time and is too sick to take all those meds orally,” he said of the aid-in-dying drugs.

But Back does tell terminally ill patients who don’t want or don’t qualify for aid-in-dying that, when the time is right and no other treatments alleviate their symptoms, “I would be willing to make sure that you get enough sedation so you won’t be awake and miserable.”

Whether palliative sedation truly ends suffering is not knowable, although doctors perceive indications that it does.

“You might be able to tell if their blood pressure goes up. Same with their pulse,” said Nancy Crumpacker, a retired oncologist in Oregon. “And you read their faces. If they are still bothered somehow, it will show in their facial expression.”

Jennifer Glass with her husband, Harlan Seymour, after she was diagnosed with cancer.

Harlan Seymour didn’t need to rely on those signs after his wife, Jennifer Glass, a well-known San Francisco public relations executive, received palliative sedation in 2015. A nonsmoker, she had metastatic lung cancer and faced a miserable death from suffocation brought on by fluids filling her lungs, her husband said.

She desperately wanted to die, he said, but aid-in-dying, which she advocated for, wasn’t yet legal. Instead, she received palliative sedation.

“The expectation was this cocktail would put her into a peaceful sleep and she would pass away” within a day or two, Seymour said. “Instead, she woke up the third night in a panic.”

Doctors upped her dosage, putting her into a deep unconsciousness. Still, she didn’t die until the seventh day. She was 52. Seymour wishes aid-in-dying had been available for his wife, but he did regard palliative sedation as a mercy for her.

“Palliative sedation is slow-motion aid-in-dying,” he said. “It was better than being awake and suffocating, but it wasn’t a good alternative.”

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