Herb & Hospice:

How Medical Marijuana Is Helping End-Of-Life Care

by Emily Berkey

While terminal patients are finding that medical cannabis offers relief with fewer side effects, health professionals must navigate legal challenges to offer aid.

While medical and recreational cannabis are currently legal in 33 U.S. states and the nation’s capital, it still remains illegal at the federal level, fostering fears of punishment for professionals within the medical establishment who may want to prescribe cannabis as a medication. Cannabis’ federal illegality not only deters discussions between doctors and patients seeking relief for various ailments, but it also greatly limits scientific research that could help assist medical experts seeking to determine cannabis’ efficacy as a treatment for certain disorders. Hospice patients and those receiving end-of-life care — a group who could arguably greatly benefit from medicinal cannabis use — are often times uninformed about the plant’s therapeutic properties, because their doctors, nurses, and other medical staffers are often hesitant to speak with patients about the advantages and risks of consuming cannabis.

“As an administrator, I can tell you it’s not that we’re not allowed to talk about the use of cannabis, but there’s a fear that the federal funding [Medicare and Social Security] could be pulled, so we just don’t know what we can and can’t talk about. But as a nurse, I feel it’s our duty to advocate for any healing measure for the patient,” says Lance Pool, the main Registered Nurse at Stoneybrook Assisted Living in Corvallis, Oregon. “I’d fear losing my job if I spoke about it… many places I’ve worked would terminate you on the spot if you spoke about cannabis use.”

Lance and Cydney Pool of Treewise Holistic Nursing Services

Armed with a desire to create change in their fields, Lance and his wife Cydney, who is a death doula (someone who assists individuals and their families in the dying process by offering physical, mental, and emotional support, similar to a birth doula), created Treewise Holistic Nursing Services, a company designed to meet the needs of elderly patients and those seeking end-of-life care with the help of cannabis as medicine. “Some of my friends who are administrators in nursing homes and assisted living [facilities] said what they really needed was an outside consultant who they could refer people who have questions about cannabis to… so that’s how Treewise got started,” says Pool. “There are a lot of elderly folks who have questions, and we’re there to answer them as an outside source.”

Treewise offers private consultation to senior citizens who are curious about or need help using cannabis for various ailments. “State regulation requires that the facilities provide for the ‘holistic’ needs of their residents… There are several ways that facilities can [do that with cannabis medications]: they can assign a “caregiver” to visit the dispensary for their residents, [or] the dispensary can “deliver” to the facility. We are licensed as a patient and [a] grower, so we can provide any of these services,” explains Pool. Although they do not sell cannabis to patients, they assist in administering it, advising, and coordinating care and communication between patients and their caregivers. “We are new to Oregon, so we are building a client base and growing our own medicine,” says Pool. “It is nice to be in a legal state where our professional licenses are relatively safe. Federal prohibition has never held us back — we are doing exactly what we want to do and always have, but federal prohibition is holding our elders back from the ‘holistic’ benefits of nature’s medicine.”

Jennifer Rosenthal Iverson, an attorney specializing in medical marijuana in Monterey, California, explains why assisted living facilities may be apprehensive to get on board with medical marijuana despite it being legal at the state level since 1996: “In California, any entity receiving federal funding is concerned because [cannabis] it’s still a Schedule I narcotic. The fear or notion that the federal government will come after an assisted living place is very far off, but if someone is receiving federal subsidies, it would be a concern.” Many hospice companies run into the same dilemmas as nursing facilities — patients who are anxious, in pain, and lacking an appetite who could potentially benefit from cannabis as medicine — and an inability to speak about cannabis for fear of reprimand or loss of federal Medicare and Social Security funding. 

T Ngu, a hospice volunteer

T Ngu, the owner of Project Object in Portland, Oregon, has been volunteering for a hospice organization for five years. “One of the families was very involved in the medication process. They really wanted to know what the medication was doing, how it was affecting them, and what the side effects are,” says T.  “It was very apparent that many of the medications made [the patient] feel anxious, have hallucinations, or made them feel worse, so they needed other medications to help with those side effects. Then they started giving their loved one cannabis-based products. They tried tinctures and she didn’t like the taste, so they started giving her marijuana chocolates. It was really apparent that when she had the chocolates, she was happier, would laugh, make jokes, was a little more present, and had less pain. When she wasn’t on them, she would scream and be more anxious and uneasy.” T is aware of the benefits of cannabis-based products, but doesn’t speak about the medication with hospice patients and their families because it’s against the hospice company’s policy. 

With staffers at assisted living, nursing home, and hospice facilities uneasy about discussing medicinal cannabis use, families with loved ones receiving end of life care are left to their own devices — often times led by a younger member of their family who discovered the benefits of such products on their own.

James Lumis, a Portland resident whose mother recently passed away, was reminded of the possible benefits of giving his mother cannabis during her time in hospice by his nephew. “He had some [edibles, which he’d made himself with recreational marijuana], so I asked my mom if she was open to trying it so she could eat, and she was,” explained Lumis. Not only did the cannabis products help his mother’s appetite, but they seemed to relieve painful constipation caused by her prescription painkillers, while easing her anxiety and diminishing her pain. Due to a lack of research and resources to consult regarding proper dosages and strain types, James tested the products on himself before giving them to his mother. “I didn’t give her anything until I tried it. I was her guinea pig,” he adds.

James Lumis of Portland, Oregon

“If cannabis was federally legal, I feel like I would have had more information when I needed it,” says Lumis. Cannabis’ federal illegality not only deters care providers from prescribing cannabis-based products, but it also results in a lack of reliable research, as many U.S. institutions have been dissuaded by the plant’s controlled legal status. With Canada’s newly adopted cannabis policies, physicians have expressed excitement about the scientific findings expected to come from a country now free of many previous restrictions on marijuana studies

Dr. Allan Frankel, a physician based in Santa Monica, California, recognizes the lack of resources surrounding cannabis dosing recommendations for hospice patients and those in need of end-of-life care. Dr. Frankel, who says he cured himself of a debilitating viral chest infection by using cannabis, offers in-office and phone consultations for patients who are seeking more information on medicinal marijuana — a service that James Lumis and his mother likely could have benefited from. “I think the odds of the federal government stepping in on an 85-year-old lady, who’s on death’s door getting some relief in a legal state from cannabis, are slim,” says Dr. Frankel.  

As far as potential consequences of doctors in California prescribing medical cannabis, attorney Iverson says that if the federal government wanted to get involved, a revocation of medical license would be the worst case scenario; “But that decision is really on a state by state basis… I haven’t heard of any cases in California where there’s been reprimand for this… But then, there aren’t many doctors that will do it.“

Dale Gieringer, the director of California’s branch of NORML (the National Organization for the Reform of Marijuana Laws), has been on the front lines of cannabis legal reform long before the Golden State’s passage of Proposition 215 in 1996 — the nation’s first medical marijuana law. Advocates battling HIV/AIDS (then an often terminal disease), along with senior citizens suffering from cancer, were instrumental in building support for California’s first medical cannabis program. However Gieringer explains to MERRY JANE that originally, “Prop 215 was in no way intended to be limited to terminal illnesses. Our opponents tried to paint it that way so as to limit its application, but we were very definitive about it being for any disorder for which marijuana provides relief.” 

He foresees marijuana being legalized on a federal level in the near future: “Most of the [federal] legislation now is all-out legalization of some sort. I think the bill that has the best chance of approval is a bill called the STATES Act, which basically says that anything that’s legal under state marijuana laws will be considered legal under federal law.” Gieringer believes that after the presidential election in 2020, there’s a good chance the U.S. may see federal reform. “I’ve never been one to predict that legalization was just around the corner, but I can see it now… even the head of the [U.S. Food and Drug Administration], Scott Gottlieb, said that federal reform looks inevitable.”

Until then, medical professionals and caregivers for patients approaching the end of their lives will have to continue using their best judgment on how to navigate the remaining legal challenges around medicinal marijuana. Echoing nurse Lance Pool’s belief of doing what’s best for the patient, Dr. Frankel says, “We have to all be a little braver just to do the right thing. You decide what’s best for that patient in that moment, and you do it. If you do anything short of that, you’re not practicing according to [medical] code.”

Complete Article HERE!

The Growing Acceptance of Medical Aid in Dying

More and more voters support options to allow the terminally ill to peacefully end their suffering. Politicians have little to fear from the issue.

By Kim Callinan  

While expanding and protecting health care was the number-one issue for voters on Nov. 6, what has gone unreported is that elected officials can now safely run on the issue of expanding and protecting end-of-life care options. For decades, lawmakers feared that sponsoring medical aid-in-dying bills that would allow terminally ill adults to have the option to peacefully end their suffering would harm their chances of getting re-elected. This year’s elections proved those concerns false.

Nearly all of the lead sponsors of bills in 28 states to authorize medical aid in dying in 2017 and 2018 who ran for re-election won (13 out of 14 state senators and 49 out of 53 state representatives). Voters also elected or re-elected at least five governors who publicly supported medical aid in dying: David Ige in Hawaii, Gavin Newsom in California, J.B. Pritzker in Illinois, Gretchen Whitmer in Michigan and Michelle Lujan Grisham in New Mexico. (Grisham’s opponent, Steve Peace, vehemently opposed medical aid in dying.)

In addition, Congressman Keith Rothfus of Pennsylvania, a sponsor of a failed resolution to overturn Washington, D.C.’s Death with Dignity Act and another House resolution condemning medical aid-in-dying laws nationwide that garnered only 13 co-sponsors, was defeated for re-election.

None of this should be particularly surprising. A majority of voters embraced this issue long before many elected officials and political candidates did — since 1996, according to Gallup’s annual polling; its 2017 poll shows that 73 percent of Americans support medical aid in dying, including 81 percent of Democrats and Democratic-leaning independents and 67 percent of Republicans and Republican-leading independents. In short, medical aid in dying is a rare bipartisan/nonpartisan issue. Five GOP legislators are among sponsors or co-sponsors of bills allowing medical aid in dying.

This unusually strong, wide-ranging support explains why 29-year-old Brittany Maynard, who moved from California to Oregon in 2014 to access its medical aid-in-dying law, was able to capture the attention of the American public. Three weeks after her YouTube video went viral, generating international news coverage, a YouGov poll showed that 38 percent of American adults — 93 million people — had heard her story.

Inspired, in part, by Maynard’s advocacy, since 2015 California, Colorado, the District of Columbia and Hawaii have enacted medical aid-in-dying laws. Today, D.C. and seven states accounting for nearly one out of five Americans have the option of medical aid in dying.

This movement is picking up major momentum, particularly among the millions of baby boomers who have watched their parents die in needless suffering because they did not have the option of medical aid in dying.

In addition, we know that these laws improve care by prompting conversations between doctors and patients about all end-of-life options, including hospice and palliative care. Oregon’s 1994 Death with Dignity Act has helped spur the state to lead the nation in hospice enrollment.

This helps explain why a 2016 Medscape survey of physicians showed doctors supporting medical aid in dying by nearly a 2-to-1 margin, 57 percent to 29 percent, up from 46 percent support in 2010. Just last month, the American Academy of Family Physicians dropped its opposition to medical aid in dying and adopted a position of “engaged neutrality,” noting that “family physicians are well-positioned to … engage in creating change in the best interest of [their] patients.” Medical societies in D.C. and nine states have adopted similar positions, and the New York State Academy of Family Physicians has endorsed allowing medical aid in dying.

Perhaps the most important benefit of medical aid in dying is that it is transforming end-of-life care in the same way childbirth care was transformed decades ago. As more states implement medical aid-in-dying laws, more and more patients have a voice in how they live the final chapter of their lives and how they die. Just as obstetricians and gynecologists now ask women for their input about who they want in the birthing room and whether they want to receive medication, doctors in states where medical aid in dying is authorized now are engaging in similar conversations with terminally ill patients.

In time, we will live in a world where health care providers fully inform their terminally ill patients about the benefits and burdens of all available forms of treatment and where deciding to end suffering and allow for a peaceful death will be a widely accepted medical option. The sooner we get there, the better.

Complete Article HERE!

‘I was widowed at 23, young people need to talk about death’

Amy Molloy and husband, Eoghan

By Amy Molloy

‘They say you’ve got three months to live.” These were the words I spoke to my then-fiancé when I was 23 years old after learning that his cancer – malignant melanoma that spread to his liver, lungs, pancreas and brain – was likely to be fatal.

At the time, my only experience of “the end” was watching my parents disappear into a room where my grandparents were lying, and of seeing an empty rabbit hut at the end of our garden after the loss of a pet.

When I was 17 years old my father was paralysed from Hodgkins Lymphoma but, after a stem cell transplant, he defeated the odds and made a miraculous recovery. So, I had faith in the power of modern medicine over mortality.

However, not this time.

I was practically still a child when a doctor ushered me into a private room, whilst my soon-to-be husband, Eoghan, was in a chemotherapy session, and revealed his prognosis. I asked if I could be the one to tell him, and they readily agreed.

Perhaps, even doctors will do anything to avoid saying the T-word. Terminal.

In the next three months, I had a crash course in end-of-life conversation: the jargon, the euphemisms and the social awkwardness.

I froze with fear when I walked into the chemo ward and heard another patient ask my partner, “Have you ever thought about euthanasia?” But, in a way, that was better than the wall of silence.

After my husband died three weeks after our wedding day, even my closest friends evaporated or became stiff in my company. In the next few months, as I rebelled against my grief – drinking too much and becoming promiscuous – nobody dared challenge me or raise the topics I ached to discuss.

What on earth are you doing?

Do you really think this is helping you?

How does it feel to marry a man who is dying?

…Do you want to die too?

Do you know what to say when a friend’s loved one dies? Have you thought about the day your own parent, partner or best friend may no longer be visible? How would you discuss it, in a way that would be supportive, constructive, and even light-hearted?

If you don’t know the answer, you’re not alone.

A new study from the Royal College of Physicians in the UK has urged medical professionals to improve their bedside manner when it comes to discussing death, after identifying that “timely, honest conversations” about patients’ futures are not happening. However it’s not only doctors who need to become more comfortable with these conversations.

It’s been suggested that millennials are the generation most fearful of death, unlike our grandparents, raised through world wars, who learnt that life can be short. As medicine advances and life expectancy increases, we prefer to think of death as our “future self’s problem”.

But is postponing the inevitable increasing our terror of it?

As psychologists report a rise in young people presenting with anxiety linked to death, it’s time for honest, open, educational conversations about loss of life, and how it can look. Its not enough to be aware of Facebook’s ‘death policy’, warn experts.

“Death is still a certainty even if people are living longer,” says clinical psychologist Renee Mill from Sydney’s Anxiety Solutions CBT.

“When treating anxiety, exposure is what works and avoidance increases the problem. Talking about death or visiting a dying person will decrease your fear of death and make it easier to accept that it is a part of life. Every funeral we attend, no matter how hard, actually helps to reduce anxiety in this way too.”

And, it’s never too early to think about the end. Planning in life is important,” says Mill. “We plan our careers, we save, we want to buy property – end-of-life is another part we need to plan. It means we get our wishes fulfilled and gives guidance to our loved ones who otherwise have to pick up the pieces.”

In a good way, change is happening. Since 2017, the multimedia project We’re All Going to Die has encouraged people to embrace their immortality and use it to empower their lives, through educational films and festivals.

The award-winning podcast, GriefCast, hosted by comedian Cariad Lloyd whose father died when she was a teenager, sees entertainers speak with startling honesty – and surprising humour – about death, from the logistics of palliative care and funeral plans to the long-term effects of bereavement.

When we can talk openly about death, we may also increase our chances of reducing suicides. To help people to help each other, Lifeline offer an online course in QPR – the equivalent of CPR for people experiencing a suicidal crisis.

As part of the training – which only takes an hour and costs $10 – people are urged not to tiptoe around the conversations. Instead, be direct: “Do you feel like you want to die?”

In our social circles, we need to discuss worst-case-scenarios. Do you have a will? Do you have death insurance? Are you an organ donor? As an Australian immigrant living 16,000 kilometres from my parents, I always have enough money in my bank account for an emergency flight home. Because, nobody lives forever.

It’s confronting but it’s necessary

During my book tour, I cried on stage for the first time whilst discussing my journey from a 23-year-old widow to a 34-year-old wife and mother of two. Because, for the first time in a decade, I have reached a place where I can talk about my experience of death – and really be heard.

I shared the reason I light a candle in my bedroom every evening and say a prayer: help me to act from a place of love, not fear.

“If my dad’s cancer comes back, on that day I will light that candle,” I said, “If my husband, who is here with my newborn, dies and I am widowed again then I will light that candle to remind myself to act from a place of love.”

We need to talk about death to be active participants in the full spectrum of life: so we can decide who to be when a doctor pulls us into a private room, when we answer the phone to bad news, when we say goodbye for the last time.

We are so scared of death, we don’t discuss what an honour it is to watch someone die; to be present – really present – when someone takes their last breath, to lean in and breathe them in, to put your head on their chest as their heart stops beating and kiss their skin as it transforms.

I hope you all have that experience one day.

We are not meant to say that, but we should.

Complete Article HERE!

Death doulas can fill care gaps at the end of life

Palliative care nurses, social workers and people from the funeral industry are among those who work as death doulas.

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With continual advances in modern medicine, we’re enjoying longer lives. As the population ages, and particularly as many people are living longer with cancers and chronic diseases, end-of-life care is adapting and changing.

People who are approaching the end of their lives will usually spend some or most of their time at home, requiring care and support to do so. Family members might not always be available to provide this care. When they are, the process can be rewarding, but it can also be challenging and complex, often leading to a severe emotional burden for the carer.

Gaps in our health and social care systems are starting to be filled by death doulas. But beyond providing practical support, families are increasingly seeking the services of death doulas to help navigate the experience of dying. Those nearing the end of their lives, too, may bring in a death doula to ensure they can die the way they want to.

We urgently need a conversation about death doulas and new models of care at the end of life. We are continuing to build an evidence base through research with the death doula community and via consultation with the health services that interface with death doulas.

Defining the death doula

We’ve seen a similar concept in midwifery, where birth doulas have long been providing social, emotional and practical support to help women through the process of childbirth. This has been shown to have positive outcomes for mothers and their babies.

Like birth doulas, death doulas’ roles and functions are non-medical; these can include advocating, supporting (spiritually and sometimes physically), guiding, and providing emotional support to the person and their family, mainly in the home.

We undertook a systematic review of the literature to find available evidence about the death doula role. We found little formal academic literature describing the role, their training, or contribution to individuals, families and the health system.

But what we do know is that each death doula enacts the role differently. They might spend time with the dying person, offering emotional and spiritual support, and sometimes providing physical care. They might support the family carers in the work they are doing. Some death doulas are only present in the last days of life, offering “vigiling” – sitting with the dying person so they are not alone.

Some doulas offer after-death rituals such as helping families prepare the body or keeping the deceased at home.

A death doula can provide additional support to family members acting as caregivers at the end of life.

Some death doulas are paid by families who engage their services. Families have often found their chosen doula online or through word-of-mouth. Other death doulas work voluntarily, in a similar way to a hospice volunteer. But, because there are no formal structures or registers, we don’t know how many death doulas there are.

In Australia and elsewhere, palliative care nurses, social workers and those from the funeral industry work as death doulas. This seems to be a natural progression, but it’s a grey area: doulas are providing care, but are not registered or supervised.

There is little formal assessment to guide patient and family choice or to inform end-of-life care provided by professionals.

How can doula care be formalised?

Providing care in homes can be informal. It may be provided by families, friends, or community groups. Care can also be formally negotiated and provided by health services, aged care providers or private agencies.

It’s necessary to understand the implications of the death doula role. For example, they could become part of formal care arrangements such as home care packages or via private health insurance funding.

We also need to look at how these new roles are authorised to represent the dying person, as they are neither a family member nor a qualified health professional. It’s also important that they are appropriately trained and insured (if providing paid services).

There are personal, social and cost advantages in enabling care in the home for a dying person. For families, being able to support the person in a familiar environment can be a powerful motivator to engage a death doula to fill the gaps in care provision.

For the health system, care in the home is seen as positive. It can avoid unnecessary hospital use and help spread the costs of caring.

For the dying person who may prefer to die at home, it is a way of achieving this. Importantly, death doulas can improve the dying person’s ability to control their own care.

The death doula role may well incorporate some of the direct care provided by families and help them to navigate the complex needs and planning required at the end of life. If so, death doulas could represent an important opportunity to improve dying outcomes.

We need to ensure our community is informed, health service provision crosses both hospitals and homes, and that those providing care – regardless of setting – have skills and knowledge appropriate to their role.

Complete Article HERE!

What if psychedelics could revolutionize the way you die?

By

My story begins eight years ago, when I was approached by my first client requesting that I supervise her in a therapeutic session with a psychedelic medicine.

She had debilitating depression and anxiety brought on by a breast cancer diagnosis. Although she had survived her cancer, she couldn’t shake her terrible emotional distress. She had tried therapists, pills and a residential program. Nothing had worked.

Then she came across stories in the media about research at UCLA using psilocybin (the active ingredient in magic mushrooms) with cancer patients suffering from what was called “end-of-life distress” and how this new treatment was showing really promising results.

She was desperate to try it for herself.

Well, as a licensed therapist and academic, could I help this woman? Reading the research literature, I learned that psychedelic research was becoming well-developed as a treatment for the psycho-spiritual depression and “existential anxiety” that often accompany the diagnosis of a life-threatening illness.

I also found myself in a bind: The science was telling me that psilocybin is the treatment most likely to benefit patients with existential anxiety when other treatments have failed; my ethical code from the B.C. Association of Clinical Counsellors tells me to act to my client’s benefit; federal law forbids me to use this treatment.

This is why, together with colleagues in the Therapeutic Psilocybin for Canadians project, I filed an application with Health Canada in January 2017, seeking a so-called “Section 56 exemption” — to permit us to provide psilocybin-assisted psychotherapy to patients with terminal cancer.

Immediate decrease in death anxiety

Dinah Bazer found relief from cancer anxiety by being treated with a dose of psilocybin administered by a New York University study.

Recent research at Johns Hopkins Medical Centre and New York University indicates that treatment of this end-of-life distress with psilocybin-assisted psychotherapy is safe and effective.

The research indicated it led to immediate, substantial and sustained decreases in depression, death anxiety, cancer-related demoralization and hopelessness.

It resulted in increased quality of life, life meaning and optimism. And these changes had persisted at a six-month follow-up.

Patients attributed improved attitudes about life and death, self, relationships and spirituality to the psilocybin experience, along with better well-being, life satisfaction and mood.

It is heartening to see research moving into Phase 3 clinical trials that will involve many more research participants. However, the foreseeable future for Canadians who need this game-changing therapy is not especially rosy.

At our current rate of progress, it may well still be years before psilocybin successfully completes Phase 3 trials and becomes available as an orthodox medicine.

Therapists risk criminal penalties

In the meantime, many Canadians with terminal cancer are also suffering from end-of-life distress, and are in dire need of relief — now.

They face serious and life-threatening illness. Their condition is terminal, so concerns about long-term effects of psilocybin are not relevant. They suffer from serious end-of-life psychological distress (anxiety and depression) to the point that it interferes with their other medical treatments. And this distress has not successfully responded to other treatments.

Psilocybin is currently a restricted drug, meaning that therapists risk criminal penalties if they aid or abet its possession. That means that we cannot recommend or encourage its use.

My professional Code of Ethics, however, states that our ethical duty is to act in a way that serves our clients’ “best interests.” The service we provide has to be “for the client’s benefit.” We must “take care to maximize benefits and minimize potential harm.”

A compassionate, humanitarian death

I agree with the Canadian medical establishment that, in ordinary circumstances, new medicines should be made available to Canadians only when they have successfully completed Phase 3 clinical trials.

In the New York University study a pill, containing either a placebo or psilocybin, was presented to the subjects in a chalice.

But I contend that the patients described here are not in ordinary circumstances. They have terminal cancer. All other treatments have failed them; they have nothing left to lose. They have the right to die; surely they have the right to try!

These patients deserve access to a still-experimental but promising medicine on compassionate and humanitarian grounds. Because of their extraordinary medical straits, psilocybin now for them represents a reasonable medical choice; it is necessary to them for a medical purpose.

Our application to Health Canada seeking a “Section 56 exemption” will be ruled on very shortly.

We fully expect that it will be denied — for political, not scientific reasons. Justin Trudeau’s Liberal government is likely in no mood to loosen up on psychedelics before the dust from the legalization of cannabis has fully settled. I think the government would like it if someone else made that decision.

Violation of our rights and freedoms

If our application is denied, we intend to file for a judicial review, and if necessary, a lawsuit in Federal Court challenging that denial.

We believe that prohibition of access to psilocybin for a legitimate medical purpose violates a citizen’s Canadian Charter of Rights and Freedoms Section 7 right to “life, liberty and security of person.”

This clause has already been interpreted by the Supreme Court to imply that a citizen has the right to autonomy in making health-care decisions. Charter-based arguments have already led to success in three recent landmark medical cannabis cases.

We argue that what applies to cannabis also applies to psilocybin:

The prohibition of … cannabis “limits the liberty of medical users by foreclosing reasonable medical choices through the threat of criminal prosecution. Similarly, by forcing a person to choose between a legal but inadequate treatment and an illegal but more effective one, the law also infringes on security of person.” Supreme Court of Canada, R. v. Smith, 2015

One thing that unites all of us human beings is that we will die. Imagine if, when our time comes, we could all have the option to die peacefully, with acceptance, without anxiety.

Complete Article HERE!

Death as a Design Challenge

Last year Elaine Fong’s mother used the Washington Death with Dignity Act. Elaine shared the experience of helping her mother fulfill her end-of-life wishes in a TEDx San Francisco presentation in October 2017.

Elaine told us, “Our family is grateful to have given our mom a peaceful death and to fulfill her end of life wishes in this way. I wanted to share the experience we had with the world, because I understand how important it is to have this honest conversation, and because it was her wish to help others be brave too. Her life would have ended painfully if it were not for this policy and the work you all have done.”

When End-of-Life Plans Are Just Hopes

Why her mom’s living will turned out to be useless

By Lola Butcher

Mom’s terminal cancer diagnosis took her by surprise. “I always thought I would just fall over dead while I was walking across the backyard,” she told me. “Not me,” I responded. “I’m planning to go out like Uncle Ernest: Go to bed healthy and wake up dead. I think it’s called cardiac arrest.”

We were sitting at Mom’s kitchen table, trying to pretend everything was OK. A few years earlier, Mom had flitted away “a little bit of cancer,” as she called it, with a lumpectomy carefully timed so she did not miss her volunteer gigs. But we knew that this time — two cancers and increasing shortness of breath — was going to be different.

We tried to focus on the peach cobbler in our bowls. In our minds, though, we were coming to grips with the fact that we had fooled ourselves.

Mom and I thought of ourselves as great planners. Our pantries always well-stocked; the menu always worked out weeks before the big family dinner; a hundred-dollar bill always tucked in the sock drawer, just in case.

Mom’s End-of-Life Plan

Mom’s end-of-life plan was to die quickly. It turns out that is not a plan; it’s a hope. And the difference proved terribly sad when it came to the living will she’d prepared (a living will is an advance directive spelling out your desires regarding medical treatment if you’re no longer able to express them).

Like every good planner, Mom had a Plan B if she didn’t get the sudden death she was counting on. She was such an enthusiast for having a living will that I teased her about handing out copies like they were campaign flyers. When she turned 65 or thereabouts, she presented a copy to each of us four kids, her siblings and her doctor, along with a warning that “if you keep me alive on machines, I’ll come back to haunt you.”

That made us laugh. Mom was as threatening as a worn-out quilt. And after Dad died, when they were both in their mid-50s, she devoted the next three decades to making other people’s lives easier. She was a cookie-baking grandma happy to babysit on five minutes notice; the lady who made hash brown casseroles for bereavement dinners at her church.

Mom’s Living Will

Looking back, I wonder where she got all those copies of her living will. In my mind’s eye, I see her — super-white tennis shoes and polyester slacks — standing next to the copy machine at the library, fishing dimes out of her coin purse, while a young library intern pushed the button. “I better get a couple more copies, if you don’t mind. My kids lose things like you wouldn’t believe,” she might have said.

We all knew the living will was Mom’s way of saying she didn’t want to die like my dad did, suffering horribly from lung cancer treatments known to be futile even before they started.

What we didn’t know is that she would suffer horribly because we didn’t adequately plan for her end-of-life care — and that the living will would prove useless.

Our Big Mistake

Mom was of the “whatever you think is best, doctor” generation, but none of her kids are wallflowers. Yet we were unprepared to advocate for Mom’s end-of-life preferences, so we politely acceded to her physician’s auto-pilot protocol of tests and specialists in unfamiliar medical centers and painful blood draws even though Mom was clear from the outset that there would be no chemotherapy and radiation.

Years earlier, my cousin had complained about the hospice nurse that cared for her dad, but I changed the subject, murmuring about how nice the funeral was. So I missed the opportunity to find out what had gone wrong, what was the name of the hospice and, most importantly, how we could avoid the same mistake if we needed hospice services in the future.

That turned out to be our big mistake.

We were caught off-guard on the day that Mom was too weak to get out of bed and I couldn’t turn her. Although we did have options (in-home help, inpatient hospice in the city 75 miles away or the local nursing home), during Mom’s months-long decline, we had not discussed them because we were hoping —there’s that word again — we wouldn’t need them.

The Hospice Trouble We Encountered

I woke up that morning, expecting another day of helping Mom from her lift chair to wheelchair to toilet to hospital bed. When we realized it was not to be, I panicked. I administered the first dose of morphine for the day and, as Mom dosed, started frantically trying to make a plan that should have been made weeks earlier.

The home care agency in her town, it turned out, only served patients not on hospice; they had a list of nurses who moonlighted, but nobody could be arranged on short notice.

The inpatient hospice had an opening, but that would mean Mom spending her last days in the city, too far for her five siblings to visit. Would she want that? In her frail and despairing condition, I couldn’t bring myself to ask.

So we headed to the nursing home, where Mom died 10 days later.

Before all this, I would have said that our one end-of-life plan was that Mom would not die in a nursing home that was just as miserable as we all feared it would be. But what I really meant was that was our hope. We didn’t have a plan.

Complete Article HERE!