Why you should swap your bucket list with a chuck-it list

By Valerie Tiberius

On my father’s 75th birthday, he announced some news: He no longer intended to learn Spanish. He told me that for most of his life he imagined he would one day speak the language fluently, but this year, at this new age and vantage point, he was giving up that goal.

He seemed a little melancholy about it but mostly relieved that he no longer had this piñata of shame hanging over his head.

Best of all, he adopted a mental heuristic for this goal-no-longer that I believe has liberating potential for everyone: Learning Spanish, he told me, was now an item on his “chuck-it list.” (Full disclosure: My dad’s name for the list is a little saltier).

Bucket lists can be a fun, inspirational tool — they encourage us to chase new experiences, such as learning chess or going on an African safari. But let’s face it: They can also be oppressive, irritating reminders that you can’t afford that $3,000 flight to Johannesburg.

As a philosopher of well-being, I can tell you that philosophers tend to divide into three camps on the subject: hedonists, who think well-being is all about good feelings; objectivists, who believe we live well when we achieve things with value transcending the individual; and desire satisfactionists, who think well-being means fulfilling your own goals.

I am in the third camp. I like that this approach respects individual differences and explains why there are so many different good lives. But it also has a serious flaw: Focusing on pursuing our goals often leaves us running on a treadmill of desire and frustration.

The solution to this problem lies in choosing which goals to pursue. The mere pursuit of a goal won’t promote your well-being — you have to be selective. This is where the chuck-it list comes into play.

Are you the kind of person who is going to be on your deathbed regretting that you missed your chance to ride in a hot-air balloon, like Dorothy in “The Wizard of Oz”? Then do it! But when I really thought about that long-held fantasy, I let it go pretty easily, along with parasailing and completing a “century” (a 100-mile bike ride). I felt liberated when I moved these activities to my chuck-it list. It freed me to think about what I actually want to do — which is, turns out, shorter bike rides and flying only in the safety of a commercial airplane.

Of course, building the chuck-it list can be difficult. In his book “Four Thousand Weeks,” Oliver Burkeman reminds us of the old time-management trick of thinking of your goals as rocks that you have to fit into the glass jar of your life. The advice is to put in the big rocks (important goals) first because otherwise you’ll fill your jar with little, unimportant pebbles and won’t be able to fit in the big ones later.

Burkeman dislikes this advice: He points out that the metaphor presupposes that we can squeeze in all the big rocks if we start with them, which might not be true. I agree. Sometimes, it’s a big rock that we have to move to the chuck-it list.

Discarding goals that we really care about is difficult; failing to complete them can elicit sadness or regret. For my father, the relief of letting go of speaking fluent Spanish came tinged with sadness because he saw learning a foreign language as valuable. When you move things to your chuck-it list because you can’t physically do them anymore (e.g., a marathon), there’s also likely to be a layer of disappointment about aging and the reminder of mortality. The same can be said about goals on a bucket list made impossible by financial constraints or time limitations: They force us to come to terms with circumstances beyond our control.

So what should we do about these negative feelings?

My neighbor, a retired pianist and choir director, told me she took learning certain difficult musical compositions off her bucket list. She described the resulting feeling as “sweet loss” — sweet because she can still listen to those beloved pieces, loss because she’s not going to be the one playing them.

Accepting this wisdom requires a shift in perspective. Bucket lists tie the value of our dreams to our value as individuals. Once we cut that tie, we can still appreciate the value of our abandoned goals by finding pleasure in the achievements of others.

Shifting away from a self-centered perspective can help giving up goals feel a bit less bitter. And really, what is the alternative? Keep everything on your bucket list and try to stuff all the rocks into the jar? This inevitably leads to disappointment and frustration. It might also lead to missing out on enjoying what wasn’t on your bucket list — things brought to you by serendipity that you couldn’t plan for, or things you’ve been taking for granted.

This is why I believe your chuck-it list is just as important as your bucket list. As you age, you grow into a different person with new priorities; your goals should evolve, too. Give yourself permission to remove those items you’ll probably never get to. And most important: Don’t feel so bad about it.

Complete Article HERE!

Terminal illness

— Navigating the struggles of acceptance

By Linda Thomas, RN

Reality knocked me for a loop one evening when my father-in-law called from his home in another state and asked for help. This kind of request was very uncharacteristic for him. We responded immediately and drove to his home. After much conversation and many questions from both sides, we eventually came to the hard truth. His cancer had progressed and, to my mind, was most likely terminal. I dug in and started contacting his doctors, trying to sort out his health issues and prognosis. This took most of a day. I came to realize he was seeing nine physicians! He was in a desperate state of denial. The oncologist repeated that he had been very open and clear with my father-in-law about the cancer and its spread.

My father-in-law had been readmitted to the hospital with a very determined but misguided surgeon. My father-in-law thought the surgery proposed by the surgeon would be a cure. It wouldn’t be, and I had the unenviable task of discussing end-of-life matters with the patient, something the surgeon should have been upfront about.

Hospice came to the hospital to discuss the care they could offer him at his home. He elected to enter into hospice, and we took him home. At this point, he was feeling fairly well, and he had a glorious two weeks with friends and family coming for visits from many miles away. Meanwhile, I quickly discovered I was in unfamiliar territory when it came to his care. It was increasingly difficult for me to care for someone I loved and had a close familial bond with. The amounts of medication he was allowed, the hard decisions I had to make… all were uncomfortably entwined with the closeness of being family. He asked for teaching regarding his health and prognosis, and we spent hours discussing end-of-life matters and the decisions to be made. Even though family was in touch, they were in their stages of denial. I became the liaison for the family’s questions, as well.

Uncharacteristically for me, I was struck with uncertainty, processing my grief while maintaining my professional duties. I relied heavily on the hospice nurses as they made their daily visits. The type of care I gave him, the large doses of medications that kept him comfortable… all were different when compared to my decades of working to save lives and titrating medications for patients who would, with the care given, most likely live to go home and resume their lives. I found myself relying on the hospice nurse, asking questions like, “Are you sure it’s ok to give him that large a dose of painkillers?” She worked with me, explaining how different this type of nursing was compared to the care given to save the lives of my usual hospitalized post-surgical, cardiac, neuro, psyche, burn, chronic respiratory, and emergency patients.

There were different, more intense emotions involved in caring for this terminally ill, beloved family member. I second-guessed myself in areas where I normally was quite confident. The advice that most helped guide me through the nights of caring for him was given to me by the hospice nurse. She repeated to me several times, “This is different from the nursing you are used to. You medicate this patient for his comfort… whatever it takes. You cannot overdose him. I repeat, you cannot overdose him.” So I learned a new skill. I learned to titrate medication for his comfort, to give him what he needed, without second-guessing myself. I kept him comfortable but functional.

And one night, he collapsed as he left the bathroom. He had no perceptible heartbeat. He had no perceptible breathing. After 15 minutes, he sat up and started talking! It blew my mind. Once he was settled back in bed, I teased him about him having left us to visit his favorite brother and his much-loved mother, both deceased. He suddenly looked at me with complete seriousness and said, “How did you know where I was?” He was thoughtful for the next few hours, then quietly said, “I’m ready. I’m ready to go, and I’m not afraid. I’ve done everything I needed to.” Three days later, he left us. That time there was no resurrection.

Complete Article HERE!

More obituaries acknowledge suicide as openness on mental health grows

Deborah Blum holds a photo of her child, Esther Iris, who died by suicide in 2021. When it came time to write the death notice, Blum was open and specific about the mental health struggles that led to her child’s death.

By Debby Waldman

When Deborah and Warren Blum’s 16-year-old died by suicide in November 2021, they went into shock. For two days, the grief-stricken Los Angeles couple didn’t sleep.

But when it came time to write a death notice, Deborah Blum was clearheaded: In a heartfelt tribute to her smart, funny, popular child, who had recently come out as nonbinary, she was open and specific about the mental health struggles that led to Esther Iris’s death.

“Esther’s whole thing was that people should know and talk about mental health and it shouldn’t be a secret,” Deborah Blum told KFF Health News. “The least I could do was to be honest and tell people. I think being embarrassed just makes it worse.”

Deborah Blum in the bedroom of her teen child, Esther Iris.

While it was once unheard-of to mention suicide as a cause of death in news obituaries and paid death notices, that has been changing, especially in the past 10 years, said Dan Reidenberg, a psychologist and managing director of the National Council for Suicide Prevention.

High-profile suicides — such as those of comic actor Robin Williams in 2014, fashion designer Kate Spade in 2018 and dancer Stephen “tWitch” Boss in 2022 — have helped reduce the stigma surrounding suicide loss. So has advertising for depression and anxiety medications, which has helped normalize that mental illnesses are health conditions.

The covid-19 pandemic also drew attention to the prevalence of mental health challenges.

“The stigma is changing,” Reidenberg said. “There is still some, but it’s less than it used to be, and that’s increasing people’s willingness to include it in an obituary.”

The teen’s drawings.
A card Esther Iris made for their dad, Warren Blum.

While there’s no right or wrong way to write death announcements, mental health and grief experts said the reluctance to acknowledge suicide has implications beyond the confines of a public notice. The stigma attached to the word affects everything from how people grieve to how people help prevent others from ending their own lives.

Research shows that talking about suicide can help reduce suicidal thoughts, but studies have also found that spikes in suicide rates can follow news reports about someone dying that way — a phenomenon known as “suicide contagion.” The latter is an argument people make for not acknowledging suicide in obituaries and death notices.

Reidenberg said, however, the subject can be addressed responsibly.

That includes telling a balanced story, similar to what Deborah Blum did, acknowledging Esther Iris’s accomplishments as well as their struggles. It means leaving out details about the method or location of the death, and not glorifying the deceased in a way that might encourage vulnerable readers to think dying by suicide is a good way to get attention.

A surfboard in memory of Esther Iris, with notes from their community written on it, is outside the Blum home in Los Angeles.

“We don’t ever want to normalize suicide, but we don’t want to normalize that people can’t have a conversation about suicide,” Reidenberg said.

Having that conversation is an important part of the grieving process, said Holly Prigerson, a professor of sociology in medicine at Weill Cornell Medical College in New York and an expert on prolonged grief disorder.

“Part of adjusting to the loss of someone is coming up with a story of what happened and why,” she said. “To the extent that you can’t be honest and acknowledge what happened if it’s a death due to suicide, that will complicate, if not impede, your ability to fully and accurately process your loss.”

People close to the deceased often know when a death was by suicide, Reidenberg said, particularly in the case of young people.

“Being honest can lead to information and awareness, whereas if we keep it shrouded in this big mystery it doesn’t help,” he added.

A study about caregiver depression that Prigerson recently conducted identified avoidance as an impediment to healing from grief.

“Not acknowledging how someone died, denying the cause of death, avoiding the reality of what happened is a significant barrier to being able to adjust to what happened and to move forward,” she said.

Researchers are increasingly seeing bereavement as a social process, Prigerson said, and as social beings, people look to others for comfort and solace. That’s another reason the stigma attached to suicide is harmful: It keeps people from opening up.

“The stigma is based on the perception that others will judge you as being an inadequate parent, or not having done enough,” Prigerson said. “This whole thing with obituaries is all about others — it’s about how people are going to read what happened and think less of you.”

Stigma, shame and embarrassment are among the reasons grieving family members have traditionally avoided acknowledging suicide in obituaries and death notices. It’s also why, if they do, they may be more likely to address it indirectly, either by describing the death as “sudden and unexpected” or by soliciting donations for mental health programs.

Economics can factor in — sometimes people are secretive because of life insurance plans that exclude payouts for suicides. Sometimes they’re trying to protect reputations, theirs as well as those of the deceased, particularly in religious communities where suicide is considered a sin.

Avoiding the word suicide doesn’t necessarily mean someone is in denial. In the days after a loss, which is when most obituaries and death announcements are written, it’s often profoundly difficult to face the truth, especially in the case of suicide, said Doreen Marshall, a psychologist and former vice president at the American Foundation for Suicide Prevention.

Even when people can admit the truth to themselves, they might have trouble expressing it to others, said Joanne Harpel, a suicide bereavement expert in New York who works with mourners through her business, Coping After Suicide.

In the support groups she runs, she said, people vary in how open they are willing to be. For example, in the group for mothers who have lost a child to suicide, everyone acknowledges that reality — after all, that’s why they’re there — but they don’t all do so the same way.

“Some of them will refer to ‘when this happened’ or ‘before all this,’” Harpel said, cautioning against holding all mourners to the same standard. “They’re not pretending it was something else, but using the word ‘suicide’ is so confronting and so painful that even in the safest context it’s very, very hard for them to say it out loud.”

If you or someone you know needs help, visit 988lifeline.org or call or text the Suicide & Crisis Lifeline at 988.<

Complete Article HERE!

Does a Person Know When They Are Dying?

By Angela Morrow, RN

Family members and friends of a dying loved one may wonder if the person knows they are dying. They may worry that if their loved one doesn’t know death is near, telling them might dash any hope and even make them die sooner. Here’s how to recognize the signs that someone is close to dying and why it is ok to acknowledge it.

The Important Tasks of Dying

It is natural to want to shield the ones we love from pain and sorrow. Trying to protect a loved one from the truth about their condition may initially seem like a good idea, but in fact withholding that information can lead to resentment and disappointment.

When a person knows they are dying, they have the opportunity to do five important things:1

  1. Apologize for past mistakes
  2. Forgive others for their mistakes
  3. Thank those people who matter most
  4. Say “I love you” to those they love
  5. Say goodbye

Without the opportunity to do these valuable things, your loved one could die with unfinished business.

Hope at the End of Life

It may seem like a dying person can’t possibly feel hopeful, but dying people do retain an amazing capacity to hope. While they may have stopped hoping for a cure or for a long life, they may still hope to mend relationships with loved ones and to die peacefully.

Keeping the truth about dying from the one who is nearing death could rob them of the chance to reflect on their lives and fulfill their final wishes.

Signs That Death Is Near

As someone nears the end of life, they usually experience certain specific physical and mental changes, including:2

  • Fatigue or sleepiness
  • Refusing food and drink
  • Mental confusion or reduced alertness
  • Anxiety
  • Shortness of breath or slowed or abnormal breathing
  • Hands, arms, feet, and legs that are cool to the touch

At the very end, the eyes may look glassy and the person may breathe noisily, making a gurgling sound known as a “death rattle.”

Awareness May Linger

It isn’t clear how long a person who is dying retains awareness of what is going on around them, but research suggests that some degree of awareness may remain even after the person slips from unconsciousness.

A 2014 study looked at 2,060 patients from 15 hospitals in the United Kingdom, the United States, and Austria who had been given CPR after going into cardiac arrest (in which the heart stops completely). Of those who survived, 140 were surveyed about their near-death experiences. Thirty-nine percent reported feeling some kind of awareness before their heart was restarted, but did not have an explicit recall of events.3

Often, people will lapse into a coma before they die—a deep state of unconsciousness and unresponsiveness. People in a coma may still hear people talking even when they can no longer respond. Because of this, the Hospice Foundation of America suggests that caregivers, family, and physicians should behave as if the dying person is aware of what is going on and is able to hear and understand voices.2

A 2020 study that investigated hearing in palliative care patients who were close to death provides evidence that some people may still be able to hear while in an unresponsive state. Electroencephalography (EEG) was used to measure the dying brain’s response to sound. The findings suggest that telling a person you love them in their final moments may register with them.4

They Know They’re Dying

Dying is a natural process that the body has to work at. Just as a woman in labor knows a baby is coming, a dying person may instinctively know death is near. Even if your loved one doesn’t discuss their death, they most likely know it is coming.

In some cases, the person comes from a culture or a family in which death is simply not discussed. Furthermore, your loved one may sense that others feel uncomfortable recognizing the dying process so they don’t want to bring it up.

Death can then become the elephant in the room. Everyone knows it’s there but no one will acknowledge it. Family discussions may be awkward and superficial and never reach an intimate level. In this case, the important work of mending and completing relationships may not happen.

Talking About Dying

Talking about death is rarely easy. Many of us feel uncomfortable even saying the words “death” or “dying.” Talking about it with a loved one who has been diagnosed with a terminal illness can be especially awkward.5

First, remember that you are talking to someone who is still living, and that talking about memories and shared experiences honors the dying person’s life. Experiencing sadness with the loved one is appropriate; that’s part of life, too.

If necessary, a therapist or hospice social worker with experience in this area can make these conversations easier.

Frequently Asked Questions

What does dying feel like?

While we can observe another person’s death and perhaps imagine what it feels like for them, there is no way to know what it actually feels like to die.

What are the signs that death is near?

Someone who is very close to death will likely refuse food and water. Their breathing and heart rates will slow and/or be abnormal and their hands, arms, feet, or legs may be cool to the touch. They may also be agitated, anxious, and confused.

What should I say to someone who is dying?

There is no right or wrong thing to say to a dying person. You may want to share memories or make sure your loved one knows you love them. A therapist or hospice social worker can help make conversations about dying easier.

What are the five stages of death and dying?

According to one widely-accepted theory, originally conceived of by psychiatrist Elisabeth Kubler-Ross in 1969, the five stages of coping with realizing you are going to die are denial, anger, bargaining, depression, and acceptance.6

Some Final Thoughts

As uncomfortable as it can be to acknowledge openly that a person you love is dying, it’s important to realize that the person is most likely aware that they are dying, so you don’t have to struggle with “breaking the news.” In fact, dying people often appreciate being able to use the time they have left to tell people they love them and mend certain relationships if necessary.

Complete Article HERE!

How to talk to people who are dying

— Some tips on being good company to someone who is facing their mortality.

By Gabi Lardies

One day everyone you think is cool, fun and lovely will be on their deathbed. The older they are the more likely they’ll be sick, probably with cancer, and know death is coming. If they’ve beaten you to the end, it’s likely that apart from being sad, your guts will be twisted with dread and fear, and at least some of it will manifest as social anxiety. It’s easy to fret that our trivial chit-chat about TV, accidentally stepping in dog poop, the price of cheese and whatever sports world cup is on may not cut it. Then again, straying from light topics is scary, because you might say something wrong or offensive.

“Sometimes you see friendships disappear, because I guess people get nervous, they don’t know what to say,” says Amanda Evans, a palliative care specialist. Yet she’s also seen beautiful conversations happen at people’s bedsides. “Don’t be afraid to go and see people when they’re going through this.”

Sandra*, who is preparing to eat her share of asparagus rolls and say her farewells at a celebrating life party (or living funeral), says she is looking forward to all the conversations she will have there.

Talking to people who are dying is not something most of us do often, but it doesn’t have to be scary, even when Sandra threatens to haunt you. How can we be good company to people who don’t have much time left?

Remember they are still alive

The image I have in my head of someone on their deathbed is straight off a cheap stock image website. You can barely see a human because they’re almost entirely covered up by sheets and tubes. It isn’t very flattering or accurate, just this week I’ve met a dying person who works and enjoys motorcycle riding, and another organising a party.

“Their body may be unwell, but they are the same person inside. Talk with them as you always have,” says Sandra. It seems she continues to be darkly hilarious, she says she’s been joking about alternative ways to dispose of her body once she dies.

“Just because they’re dying doesn’t mean they have a different personality”, agrees Evans. “This is the person that you’re friends with, this is the person that you care about. If they were an asshole they will still be an asshole.” She laughs, which is very much allowed when you’re around death. I’m beginning to wonder if I’m outing myself as being so afraid of death, I’ve forgotten people who are dying are, well, people. “Sometimes you do need courage to walk through the door,” says Evans, “but when you’re there, you realise that it’s actually OK.”

Trivial chit chat

When I ask Sandra if she enjoys chit-chat about ordinary everyday things, her response is quick. “Abso FKN lutley! That is 90% of what we talk about.”

Talk about death

Catherine D’Souza, who began specialising in palliative care in 2009, says even she is sometimes surprised by how open her patients are about death. “The majority absolutely welcome an open and honest discussion,” she says. In palliative care, you learn that “death is comfortable, calm and peaceful for the majority of people. It doesn’t have to be a time of suffering and despair.”

Still, one’s own death can be a lot to process. “Some people like to talk over things multiple times. They will talk about dying every day, that’s their choice. Some people don’t want to talk about it so much. They’ve had that conversation, an honest conversation, and then they feel like that’s enough,” says D’Souza.

The topic of death may need to be broached differently with children. Evans is one of only three paediatric palliative care specialists in the country, currently caring for children who are dying, through Rei Kōtuku. Evans asks if they feel like their body is changing, to which they usually say yes. Then, she asks what they think is happening. “They might turn to me and say, ‘I’m dying’.” In her experience, children aren’t as scared of dying as people might assume.

Adults often avoid the topic because they try to protect children, but “if no one’s talking about it, then it makes them feel more isolated, and more lonely and more anxious and fearful.” Evans has found that what children who are dying are most afraid of is being without their parents, so they need reassurance. “I spend time with the parents and tell them to keep saying to the child that they’re not going to be alone.”

Don’t feel sorry for them

Anna Cruse, motorcycle rider, acrobat, martial arts enthusiast and Addams Family lover has a terminal cancer diagnosis. Her cancer is not one which is causing her a lot of pain, so she is enjoying life. “I do not consider myself to be a victim. And I really really do not like it when people treat me like one,” says Cruse. Sometimes she feels people are tempted to think of her as a fragile “patient” when she tells them about her diagnosis, but “most people who know me, they know that I can’t be treated like I’m soft or delicate.”

Cruse is careful to point out she’s not a “representative of the whole dying community”. She says, “if it’s the worst pain that anyone’s ever experienced in their life, it’s going to be a lot different for them.”

By the same token, Cruse doesn’t appreciate false positivity. Sometimes people say things like “you got this,” and she thinks, “Well, yeah, I’m gonna die. This is not a battle which I am going to win.”

Evans says it’s important to remember death is not something to be “fixed”. “People don’t have to come and make it better, because there’s nothing to make better”.

HEIDELBERG, GERMANY - MARCH 30: In this photo illustration a Old man has a family photo in his hands on March 30, 2022 in Heidelberg, Germany. (Photo Illustration by Ute Grabowsky/Getty Images)
Photos can be useful prompts

Happy memories

Sandra says the conversations she has most been enjoying recently with her sons have been “laughing together about the funny things that have happened in our lives together.” Her sons have sometimes opened these conversations by asking her, “Tell me about xyz again please Mum.

Annie Meredith, an end of life doula, has some similar openers. She asks people what brings them joy in life, what’s important to them, who are their significant people and places, and asks them to think of a time when they felt most alive (not all at once). Then, she always has a couple of questions up her sleeve to help someone keep digging into their memories – Can you tell me a bit more about that? How did that make you feel?

Have some fun and whiskey

“People don’t want to be miserable the whole time. When they’re dying, they want moments of joy, they want to enjoy the remaining life that they have left,” says D’Souza, who has seen some beautiful moments in palliative care wards.

“I remember when an elderly chap was dying, all of his brothers, uncles, sons gathered around the bedside, and they all shared a glass of whiskey together and toasted him as he was dying. That was rather moving because it was his favourite drink,” she says. Others put on favourite music, or sing, to celebrate the dying person’s life.

“I hope I’m laughing until my last breath,” says Cruse, “I love to laugh. I love to have these funny things going on. Having a clown near would be fantastic. Strippers, too. And whiskey – it’s classy.”

Some of Sandra’s friends have been cracking her up by saying things like “get well soon”. Not everyone’s sense of humour is this dark, but you “gotta laugh or cry,” says Sandra. She’d rather laugh.

Ask if they are at peace

“It is quite a weird thing to say out loud sometimes, but actually when you ask it, because it’s quite vague – peace can mean different things for different people – they bring up things that are important to them,” says Evans.

It’s the type of contemplative question which might get you weird looks if you were to ask it at a friday night barbecue, or a cringe on a first date, but next to death, it’s a gentle probe to look back on life. The question could also bring up feelings of unfinished business, which, if they’re wanting to talk through them, could be juicy.

Say the wrong thing

“People always do and say silly things. It’s okay. You can have a laugh about it. You don’t have to be perfect,” says Evans. Making an egg of yourself is just life, but it is different from pressing someone to talk about things they really don’t want to. If in doubt, ask.

Tell them that you love them

This is what Sandra thinks is most important.

Its you or the op shop

Ask if you can have that dress

In Evans’ experience, this shameless honesty elicited laughter from the person dying. “It was a question that they would expect to come out of that person’s mouth, it was just that type of relationship,” she said. I’m taking this to mean that by the bedside, we don’t have to turn into angels, we can be ourselves.

On the topic of inheriting things, don’t put practical questions off the table. Asking if someone has their affairs in order isn’t necessarily in bad taste. Nor is asking them to write down all their passwords and knowing what they want done with their social media accounts. And have they planned their funeral? You can offer to help! A fun activity to do together!

Nothing at all

“Be comfortable to sit with silence, sometimes silence gives them more time to think,” says Meredith. She stresses that listening is important, and so shutting up is essential. Quiet can give the dying person a chance to bring up what’s on their mind, or for them to simply feel comforted by your radiant presence.

Evans too thinks your presence is enough, “Come and just be, you don’t need to say anything. You could just sit there and be on your phone, but being there can make the person feel less alone. There’s a lot of comfort from someone just sitting here.”

For Evans, D’Souza and Meredith, who have dedicated their careers to helping people who are dying, spending time in their company is not sad or scary – it’s a privilege. “I think some of the most beautiful conversations that I can ever have are with someone nearing the end of their life,” says Meredith, “these conversations tend to be more honest, real and authentic.”

Complete Article HERE!

A Moment in Time

— “Explaining Death to a Toddler”

Walking by a tree the other day, I noticed one brown leaf among the flourishing green. I wondered, “Why is it that this specific one died?”

By Rabbi Zach Shapiro

Dear all,

Walking by a tree the other day, I noticed one brown leaf among the flourishing green. I wondered, “Why is it that this specific one died?”

The question weighed heavily, as Ron and I are preparing to explain the death of a loved one to our toddler children.  We know there will be many questions:

Why?”

”Why now?”

”What does death mean?”

”Will something happen to you?”

”If so, who will take care of me?”

While the conversation will be difficult, we also know it needs to be straight-forward. When talking about death, it’s really important to keep the following in mind:

  1. Don’t use euphemisms. (No one “passed away” or “went to sleep.” The person died.”)
  2. It’s ok to express your own emotions and not hide them.
  3. Make sure you answer the question the child is actually asking. Be brief and simple about it.
  4. It’s ok to share: “a body stopped working” and: “it doesn’t move or eat or play anymore.” If the child asks if the body is like a toy that needs a new battery, explain that living things can’t get new batteries like toys do.
  5. Your child may or may not ask questions. Some questions may unfold over time.

Also – remember this. Every death is different. Sharing the death of an older adult is very different experience than sharing the death of a young person. And different children will respond in different ways.

Mind you, it’s one thing to offer this advice in my moment in time. It’s another to sit and have the conversation with our children. We will rehearse it. We will prepare our answers. But we will also ensure that we are not so over-prepared that we come off as staged.

It’s a delicate balance. But so is life.

With love and shalom.

Rabbi Zach Shapiro

Complete Article HERE!

I assess assisted dying requests

— This is what I do

Since the End of Life Choice Act became law, Dr Kees Lodder has been involved in assisted dying requests. Here, he explains to Alex Casey what the process entails, and what he has learned along the way.

As told to Alex Casey

People always assume it must be depressing to work in death and dying, but I’ve found it to be the most rewarding aspect of medicine to work in. You can alleviate so much suffering for someone, not just physically but also emotionally and spiritually.

I worked for over two decades as a GP before moving into palliative care in both hospitals and hospices. More recently, I’ve been assessing assisted dying requests. I’m very interested in helping people have a good death, and find it fascinating that it remains one of the biggest taboos out there.

When the End of Life Choice Act became law in 2021, I immediately went through the training programme to assess requests. Between 1 April 2022 and 31 March 2023, 328 people completed the process to have an assisted death.

Very few people know what the process actually entails. To begin, any patient can ring the Ministry of Health number (0800 223 852) and speak to one of three excellent and friendly nurses. They will collect all the information, and send it on for a first opinion assessment. The first doctor is called an attending medical practitioner (AMP), who will then contact the patient and write an extensive report on whether they’re eligible or not eligible.

The eligibility criteria is very strict. You need to be 18 or older in New Zealand. You need to be a New Zealand citizen, or a permanent resident. You need to be in an advanced state of irreversible decline in your physical capacity, with less than six months to live. You need to be experiencing unbearable suffering that cannot be released in a tolerable manner, and you need to express your wishes to die free of pressure from anybody else. It’s also crucial that you are able to process all the information and be of sound mind to make the decision. 

If the first doctor has decided that you are eligible to continue through the process, you will then see the second doctor. They are referred to as an IMP, or independent medical practitioner, which is what I do. We will talk to your specialists, your GP and hospice staff, and look through all your files to ascertain that you have less than six months to live. It is a very thorough and rigorous process – of those who have applied so far, 16% were deemed ineligible with the first opinion, and a further 3.5% by the second opinion.

I always meet with patients face-to-face, ideally with as much of their whānau present as possible. After I introduce myself and tell them a bit about my background, I always ask them the same, simple, open question: “How are you coping right now?” 

From there, it becomes really easy to have an open conversation. I’m always fascinated by what people think will happen when they die. People who say they are not religious at all will come back with the most detailed images of what they think the afterlife looks like. A number of people have told about their vivid and reassuring near-death experiences. We talk about who they want to be there when they die, who they want to remove their body and after how long, and what they want for their funeral. There’s often even room for a few jokes.

After the two assessments are done, your case goes to the registrar to be signed off, at which point you set up an appointment for your assisted death within the next six months. We tell the patients that the whole assessment process could take up to six weeks but it can be done faster depending on the availability of the AMP and IMP. The specific medication can only be dispensed from two pharmacies in the country, and consists of three steps. The first drug is to make you go to sleep, the second is a body relaxant, and then the third stops your heart. I always emphasise that it is a very peaceful process that only takes a few minutes. 

What I really find interesting is that those who are seeking out an assisted death often have very little fear of dying. The difference in attitude between people that have come to terms with the fact that they’re dying, compared to people who haven’t ever thought about their own death before, is huge. Research also shows that those who have supported their loved one in the decision to have an assisted death experience a less complex grief process, which makes sense given how much conversation, planning and support there is. 

There is definitely a cultural change happening when it comes to death, but there is still a lot more educating to be done. A lot of people don’t know what the process entails, or that they can start it without their GP or specialist. There are still many conscientious objectors in medicine that are opposed to assisted dying, including Hospice New Zealand, certain aged care facilities and individual GPs. My hope is that, one day, all our residential care facilities will accept assisted dying to take place in their premises, since this is the place that so many people call their home.  

Even if assisted dying isn’t for you, there is a huge advantage in preparing better for our own deaths and the deaths of our nearest and dearest. We will all lose loved ones, friends and whānau. So by being able to talk about it and having an increased awareness about it, we can be much more accepting of it. I’ve always said that having a plan around your death is the best gift you can give to your family. It’s something we’re all going to face, so why keep your head in the sand until it’s too late?

Complete Article HERE!