Death is part of our human experience

There are times when it is better to “let nature take its course”.

By SALLY FOSTER-FULTON

The debate around assisted dying is undoubtedly a difficult and sensitive one. However, Nelson Jones’s recent blog, conflating as it did two very different issues, served only to muddy the waters.

In the piece, Jones sought to argue that because, in certain situations, a clinical decision is made by medical personnel not to attempt resuscitation of the patient, this is essentially equivalent to the medical profession making the decision to end the life of a vulnerable person. It would be more honest, Jones argued, to allow the choice of when their life should end to be made by the patient.

There can be little doubt that medical technology is now such that we can artificially prolong the lives of people through interventions which are at times inappropriate. However, in our death-denying culture, there are times when we need to remember that death is a part of our human experience, and that not every death is the result of a medical failure. There are times when the better decision is to let go, to step back and “let nature take its course”. This is the purpose of the “do not attempt resuscitation” (DNAR) decision: that further medical intervention would be futile and of no benefit to the patient.

However, the withholding or withdrawing of medical treatment differs fundamentally from the deliberate ending of life. The Church of Scotland is active in many projects offering care, comfort and support to the vulnerable in many practical ways. We therefore find the prospect of legislation allowing assisted dying to be deeply concerning, as it has the potential to undermine focus on the care and comfort of all as they move through the last stages of life- especially those who are placed in a vulnerable position as a result of age, incapacity or other circumstance.

While personal autonomy is indeed an important issue, it is a dangerous fallacy to believe that a person can act independently of all others, with their actions having no consequences for anybody else. Interpersonal relationships are vital: life is lived and death experienced as part of community. Assisted suicide cannot be a personal choice because it will inevitably effect everyone, and how tragic if those most vulnerable in our communities begin to feel that their lives are somehow less worth our resources. What a tragically bleak view of human life- and how far removed from the call of the church to show love and concern, compassion and support for all around us.

Death, as a natural process, cannot be avoided: despite the inevitable sadness involved in saying farewell to a loved one, emphasis should be placed on ensuring that all participants in the process experience as fulfilled and comfortable a final journey as possible.

We would emphasise the need for all aspects of care to be improved; there is concern, however, that assisted dying legalisation will undermine, rather than enhance, other aspects of end of life care and the manner in which society values every human being. Clearly it would be a step too far if vulnerable patients felt pressured to opt for assisted dying because of a lack of resources to give them an acceptable quality of life in their last months.

In common with many people of faith, the Church of Scotland would affirm that the worth and dignity of every human life needs to be emphasised and celebrated. Indeed, the Gospel of Jesus Christ which the Church of Scotland seeks to live out emphasises the value and worth of all human life, no matter the circumstances. Any legislation to bring about the deliberate ending of a human life would be a sea-change in how we perceive one another. Society places a prohibition on the killing of others (because we understand the profound commonality of life): this is a line which we must not cross.

Complete Article HERE!

Permitted assisted dying could increase protection for vulnerable people

The only person who can decide if a life is worth living is the one living it.

By: NELSON JONES

Tony Nicklinson may not have achieved his wish for doctors to be allowed to terminate his life at a place and time of his choosing, but he did manage to push the subject of assisted dying higher up the public agenda than it has been for a long time. And while he didn’t convince the judges at the High Court, public opinion would seem to be firmly on his side. A YouGov poll conducted on behalf of the British Humanist Association last week found that a massive 81 per cent of adults (and two thirds of Roman Catholics) would support the right of “mentally competent individuals with incurable or terminal diseases” to access medical support to end their lives. Only 6 per cent were “strongly opposed”.

Support, too, has come from some leading politicians, such as the newly-appointed health minister Anna Soubry, who called the present state of the law “ridiculous and appalling”.

Even so, opposition to any change remains entrenched and seemingly unmovable. Many MPs, almost all religious leaders and the official policy of the BMA are implacably opposed to legalising voluntary euthanasia, which the current BMA president has described as “a journey I just don’t want us to even start out on”.

For some, the question is forever out of bounds because life is sacred and can properly be terminated only by God. But there are more pragmatic arguments, too, that convince many that assisted dying is inherently dangerous. It’s said that if the law were changed, vulnerable people would feel under pressure to end their lives in order to spare their families (or the taxpayer) the “burden” of their continued existence. That a system of planned death, timetabled according to personal or medical convenience, would cheapen life itself, would enshrine in law the idea that some lives were not worth living, and could potentially lead to a eugenic society in which the chronically sick, the elderly and the disabled were seen as disposable, by themselves or by others.

Such an argument may sound plausible. But can we be sure that we don’t live in such a society already? Today we learned of the case of an unnamed man, aged 51, with Down’s Syndrome and other disabilities, who spent some time in hospital last year. After “AWA” was discharged it emerged that without the knowledge of his family or carers doctors had placed a “do not resuscitate” (DNR) order on his file. The sole reason given for the notice – which would have resulted in his inevitable death had he suffered a cardiac arrest or encountered serious breathing difficulties – was apparently his disability. He does not seem to have been terminally ill.

We must, of course, be careful. It is only one case. The NHS trust concerned has declined to comment on the ongoing legal action and there may be significant facts that haven’t been reported. AWA’s solicitor, Merry Varney however, described it as “one of the most extreme cases we have seen” and declared that “to use Down’s Syndrome and learning difficulties as a reason to withhold lifesaving treatment is nothing short of blatant prejudice.”

“Extreme” this case may be, but problems relating to DNR notices are far from unheard of. In another case currently before the courts, David Tracey is suing Addenbrooke’s hospital in Cambridge over a DNR issued in respect of his wife who died there last year, and which was apparently discussed neither with her nor with him. He was also being represented by Merry Varney, who argued that “a competent patient must surely know when a decision to withhold potentially life sustaining treatment has been made.”

A survey of 100 hospitals carried out last year by the Care Quality Commission found that at least five were in breach of medical guidance regarding consultation with families before issuing a DNR notice. On one ward, as many as a third of such orders were issued without consultation. The charity Action on Elder Abuse described such practices as “euthanasia by the backdoor”.

Even if such cases are not the norm, they might be seen as evidence of a callously utilitarian approach to questions of life and death even without legalised euthanasia. AWA’s case in particular suggests that vulnerable patients might be especially, well, vulnerable to such an attitude. Yet others tell a different story, of elderly and vulnerable or terminally-ill people, sometimes in pain, past all hope of full recovery and who in an earlier age would have died peacefully, being artificially kept alive by well-meaning doctors and by the death-cheating power of modern medicine.

In today’s legal and medical regime, it would appear, some people are allowed to die who would rather live, while others are unwillingly kept alive when they want to die.

These two undesirable situations in fact represent different sides of the same coin: the paternalist attitude that sees medical professionals, rather than individual patients, as the people best placed to make the decision about whether he lives or dies. Tony Nicklinson, intellectually fully competent and certain in his own mind, is not allowed to determine the manner of his death. Nor is the more obviously vulnerable AWA. A system supposedly concerned with protecting the vulnerable only succeeds in reinforcing the godlike power of doctors.

For that reason, I suspect legislation that permitted assisted dying would actually increase the protection currently afforded to vulnerable people, and increase respect for the value of life. There’s no contradiction between saying that all lives are valuable and that some have become intolerably burdensome. Rather, knowledge that they would not be condemned, in extremis, to a lingering agony at the hands of modern medicine would free some patients to live. And those who chose for reasons of faith or optimism to cling to every last painful moment of life could do so without causing others to feel guilt for their plight, which is the real “burden” which people with severe disabilities or who are in the last stages of terminal illness impose on their loved-ones.

The only person capable of deciding whether a life is or is not worth living, ultimately, is the one who is living it.

Complete Article HERE!

Pot compound seen as tool against cancer

Marijuana, already shown to reduce pain and nausea in cancer patients, may be promising as a cancer-fighting agent against some of the most aggressive forms of the disease.

A growing body of early research shows a compound found in marijuana – one that does not produce the plant’s psychotropic high – seems to have the ability to “turn off” the activity of a gene responsible for metastasis in breast and other types of cancers.

Two scientists at San Francisco’s California Pacific Medical Center Research Institute first released data five years ago that showed how this compound – called cannabidiol – reduced the aggressiveness of human breast cancer cells in the lab.

Last year, they published a small study that showed it had a similar effect on mice. Now, the researchers are on the cusp of releasing data, also on animals, that expands upon these results, and hope to move forward as soon as possible with human clinical trials.

“The preclinical trial data is very strong, and there’s no toxicity. There’s really a lot of research to move ahead with and to get people excited,” said Sean McAllister, who along with scientist Pierre Desprez, has been studying the active molecules in marijuana – called cannabinoids – as potent inhibitors of metastatic disease for the past decade.

Like many scientific endeavors, connections made between disparate elements – in this case, a plant considered a controlled substance and abnormal cells dividing out of control – involved a high degree of serendipity. The two researchers were seemingly focused on unrelated areas, but found their discoveries pointing in the same direction.

Desprez, who moved to the Bay Area from France for postdoctoral research in the 1990s, was looking at human mammary gland cells and, in particular, the role of a protein called ID-1.

The ID-1 protein is important in embryonic development, after which it essentially turns off and stays off. But when Desprez manipulated cells in the lab to artificially maintain a high level of ID-1 to see if he could stop the secretion of milk, he discovered that these cells began to look and act like cancer cells.

“These cells started to behave really crazy,” Desprez said. “They started to migrate, invade other tissues, to behave like metastatic cells.”

Based on that discovery, he took a look at metastatic cancer cells – not just standard cancer cells, but those responsible for aggressively spreading the disease throughout the body. He found the vast majority tended to express high levels of ID-1, leading him to conclude that ID-1 must play an important role in causing the disease to spread.
Anticancer potential

Meanwhile, McAllister was focused on studying anabolic steroids in drug abuse. McAllister, who also made his way to CPMC from Virginia in the 1990s, became fascinated with the role non-psychotropic cannabidiol, or CBD, interacts with cancer.

Marijuana’s better known cannabinoid – delta-9 tetrahydrocannabinol, or THC – had already shown some anticancer properties in tumors, but the non-psychotropic cannabidiol had largely gone unstudied. McAllister initial research showed CBD had anticancer potential as well.

About eight years ago McAllister heard his colleague, Desprez, give an internal seminar about his work on ID-1, the manipulated protein cells that masquerade as cancer cells, and metastases. That produced an idea: How effective would cannabidiol be on targeting metastatic cancer cells?

The pair teamed up – Desprez with his apparently cancer-causing ID-1 and McAllister with his cancer-fighting CBD – deciding to concentrate their research on metastatic cells of a particularly aggressive form of breast cancer called “triple negative.” It is so named because this type of breast cancer lacks the three hormone receptors that some of the most successful therapies target. About 15 percent of breast cancers fall into this category, and these cells happen to have high levels of ID-1.

Complete Article HERE!

The Kay Jaybee Connection

Interest in The Amateur’s Guide To Death and Dying is coming in from all corners. Even from what would appear, at first glance, as unlikely sources of interest. Take for example my good friend, Kay Jaybee. She is an award-winning author of sizzlin’ erotica who lives in the UK. She and I have know each other since September 2008 when, together, we inagurated The Erotic Mind podcast series over at Dr Dick’s Sex Advice.

Kay and I don’t often get a chance to connect, our schedules and the eight-hour time difference between us often prohibits that. But when we do chat it’s like old home week. Some weeks ago we visited with one another on Skype. I was telling her about the difficulties I was facing trying to get the word out about The Amateur’s Guide. Being an author herself she understood.

Kay asked me if I would be interested in writing a guest post for her site. I jumped for the opportunity.

Of special interest to Kay’s audience, and also my favorite, is Chapter 6 of my book, titled, Don’t Stop.  I collaborated with my dear friend, the internationally known sex educator and therapist, Dr. Cheryl Cohen Greene on this chapter about sexuality and intimacy.

We begin by posing 5 simple questions to help our readers focus their attention on their sexuality and intimacy needs.

1. How important is sexuality in your life?

2. Is there’s a difference between sexuality and intimacy?

3. Do you have a range of options in which to experience your sexuality?  If yes, what are some of them?

4. How well are you able to communicate your needs for sex and/or intimacy to your partner(s)?  Are there any specific issues that get in the way of asking for what you need?

5. What are your biggest concerns about your sexuality as it relates to your disease, aging and/or dying process?

Cheryl sums up the reason for incorporating this chapter in the book.

“Sexuality and intimacy are important topics for us to consider, because there is so little information out there about these things for elders and those of us who have life-threatening conditions.  The assumption, I suppose, is that sick, aging and dying people don’t have sexual and intimacy concerns, so why even bring it up?

That ridiculous assumption is so prevalent, even among healing and helping professions, that I’m forever having to confront it with, ‘Hey, we’re not dead yet.’”

Kay published my guest posting this morning.

I invite you to take a look at the full post.  I think you will agree things have got to change.

Click on Kay’s banner below to see the posting.

Starting Over

I have this great opportunity to cross post, here, a posting I made this morning on my sex advice site, Dr Dick’s Sex Advice.

Name: LD
Gender: Male
Age: 38
Location: Atlanta
How do you jump back into the game when your partner passed away suddenly? Getting really horny but its still awkward to actually do it.

Good question, LD. You say you’re feeling awkward. Why exactly? Is it because you’re out of practice with the whole dating thing? Are you concerned that people might think you’re jumping the gun, trying to get back into the game before your partner is cold in the grave? People can be pretty heartless about this. Or, is your awkwardness associated with your grief?

Grief has a profound effect on every aspect of our lives. Yet there is hardly any literature on the effects grief has on our sexuality. To my mind, grief is the leading causes of sexual dysfunction for those who have experienced the death of a partner.

Allow me a bit of time here for one of my pet spiels. Healing and helping professionals often misdiagnose grief. I want to make one thing clear, grief is not depression. Treating grief with an antidepressant is counterproductive. It can actually take away the impetus to resolve the grief and get on the rest of one’s life.

Making sure that you have processed your grief may eliminate some of your awkwardness you are currently experiencing. This is something I’m pretty familiar with. A good portion of my private practice is with sick, elder and dying people and their friends and family who survive them. I know the impact a terminal illness and dying process can have on the surviving spouse or partner. We often go into survival mode, shutting down so much of ourselves in an effort to have the strength to cope with this life-altering experience. Of course, trying to kick-start our life afterwards is often a monumental effort. Without the support and guidance of a professional or a group of similarly challenged people, some of us just sink to the lowest common denominator.

I believe in the resilience of the human spirit. I believe that we can honor our dead and continue to live and love. It sounds to me like you have a desire to get on with your life, LD, to fill the void, to make new connections, but you simply don’t know how. Acknowledging that fact is a real good place to begin.

Perhaps you could start by reawakening your sexuality through self-pleasuring. Reconnect with your body and the joy it can bring you. Reestablishing a social life will no doubt follow, slowly at first. But the inevitable tug of the need for human-to-human contact will draw you, if you let it. Remember the best testament to those who have died is to continue to celebrate life itself.

Allow me to draw your attention to my latest book, The Amateur’s Guide To Death And Dying; Enhancing The End Of Life. Actually it’s more of a workbook then a text and while its primarily target are those currently facing their mortality it’s not exclusively for them. Concerned family and friends, healing and helping professionals, lawyers, clergy, teachers, students, and those grieving a death will all benefit from participating in the interactive environment the book provides.

Of special interest to you will be Chapter 6, Don’t Stop. My good friend and colleague, Dr Cheryl Cohen Greene, joins me in presenting this chapter on sex and intimacy concerns. Like I said above, there is a dearth of information about this timely topic for sick, elder and dying people as well as those who are grieving. So I am delighted that my book helps break this deafening silence.

I hope you take the time to write back, LD. I’d very much like to keep tabs on how you are doing.

Good luck