Going up yonder from your home

By Gerald W. Deas M.D., MPH

[D]uring my many years of medical practice, I have made many house calls on folks who were going to their eternal rest. Often, loved ones from the family have suggested that the person be hospitalized. In some cases, I had no alternative but to do so. But at other times, after surveying the home conditions and finding that they were accommodating, I have suggested to the family that I take care of the patient at home until he or she had completed the journey to the everlasting.

I am convinced that patient’s lives are extended when they are kept at home. They can hear familiar voices and songs. They can see the familiar faces of their loved ones. Often, they can taste that home-cooked food, which gives them nourishment. They are comfortable in clean beds with fluffy pillows and warm blankets. They can feel the touch of kind and gentle hands. All of their five senses are satisfied as they begin their death dream knowing that they will awaken satisfied with going home from home.

After reading the book “Ethical Ambition; Living a Life of Meaning and Worth” by the great author Derrick Bell, who recently passed, I was struck by a passage in the book that stated the following: “Life is a gift that can be revoked at any time, and that, at some point, will come to an end. And, at that end, we know our work will not be completed. Perfection will have evaded us as it has for all who came before us. If there is satisfaction, it must come from our striving toward that vision of a better world.” This statement certainly is a long quote from his book, but I think it crystallizes my thoughts on life and death.

Bell also quotes from a book by Mitch Albom entitled “Tuesdays With Morrie.” Morrie, suffering from the last stages of Lou Gehrig’s disease, tells his former student Mitch, “Everyone knows that they are going to die, but nobody believes it. If we did, we would do things differently. … There’s a better approach. To know you’re going to die, and to be prepared for it at any time. That’s better. That way, you can actively be more involved in your life while you are living.” After I read these statements from this wonderful book again, my philosophy of life and death was also strengthened.

Another book recently completed has the wonderful writing of the Rev. Paul Smith, senior minister of the First Presbyterian Church of Brooklyn Heights, entitled “The Deep Calling to the Deep: Facing Death.” This book should be read by everyone, because we all will be facing death.

Smith gives a day-to-day account of his ministry to six folks who were dying and how they and their families were comforted to know that death is not the worst thing that can happen in your life. Smith writes about the “good death” and quotes Dr. Howard Thurman as follows: “A good death is made up of the same elements as a good life.”

What is a good life and a good death? I suggest that you read this enlightened work and find out. I certainly did. I believe that all physicians, medical students and theologians should read this book as a must in their training.

Going up yonder, I feel, completes our journey on this planet, a most desirable conclusion.

Complete Article HERE!

5 ways to improve care at the end of life

By Kathleen G. Sebelius and Tommy G. Thompson

[A]ll of us face the difficult prospect of a parent or loved one suffering from an illness that ultimately leads to death. When that time comes, we will want to ease their physical and emotional pain, respect their wishes, and allow them to die with dignity — the same things we will want for ourselves.

The way that Americans die has changed but, unfortunately, our medical system hasn’t kept up. It was designed at a time when death was often sudden or declines in health were relatively rapid. These days it is much more common for people to live longer with multiple chronic conditions, and we have the technology to prolong life as death approaches. End-of-life care is fragmented, intensive, and costly — and patients’ wishes are often lost due to poor communication.

As baby boomers continue to age, swelling the ranks of the elderly and those near death, how seriously ill people approaching the end of life are cared for must be reformed. We had the honor of chairing the Aspen Health Strategy Group, composed of 23 experienced leaders in health care, technology, and the media, as it explored ways to improve care at the end of life. Here are five of the transformative ideas we included in the group’s report, “Improving Care at the End of Life.”

Emphasize planning for the inevitable. Creating an advance directive and speaking to loved ones about end-of-life care wishes should be as natural and commonplace as financial planning. Far too many care decisions are made by family members who are only guessing at the wishes of their loved ones. It’s awkward to talk about death and dying, but necessary. By integrating advanced care planning into things we already do in our daily lives like using smartphones or making employee benefit decisions, we can encourage these much-needed conversations.

Refine Medicare coverage. Two serious gaps in health insurance coverage threaten many people facing the end of life. Medicare does not provide coverage for social supports, like breaks for family caregivers, or for the coordination of care. Medicare policy should be changed to include benefits for those diagnosed with advanced illness that provide social supports and care coordination through a defined care team. This kind of coverage would encourage team-based organizations to meet the needs of patients. Medicare should test the integration of its hospice benefit into Medicare Advantage and other demonstrations. Improving efficiency and delivery will help those who are seriously ill get the care they need — and help their caregivers deliver it — without jumping through hurdles and battling a bureaucracy not designed with their circumstances in mind.

Measure the effectiveness of end-of-life care. Only by understanding how well health care and social services support individuals at the ends of their lives can we understand, demand, and reward good performance by their caregivers. So we need to develop metrics that can provide accountability and transparency. In addition to measuring the quality of care, these metrics must also measure patient preferences and families’ experience as they care for their loved ones.

Train more clinicians in palliative care. Graduate medical education includes little training on the needs of patients in the last years or days of their lives. We need to create financial and professional incentives to expand the number of doctors, nurses, nurse practitioners, social workers, and other health care professionals who have the right training to effectively and compassionately provide end-of-life care.

Get community input on better models of care. Addressing this urgent need will create disruptions in how health care is delivered. Leadership by policymakers and private sector leaders is required to improve end-of-life care, but so is a social consensus that such a change is needed. This can happen only at the local level. Some communities will rise to this challenge. Those that do so successfully should be held up as examples and the lessons they learn shared with others seeking to achieve the same ends.

We sincerely hope that health care policy leaders will take this problem head-on. Much more can be done to make sure that all Americans die according to their wishes and with dignity. By implementing the ideas outlined above, we can make important strides to that end.

Complete Article HERE!

Why Older People Are Vulnerable to Fraud, and How to Protect Them


[O]lder people who are active investors and who prefer unregulated investments may be more susceptible to investment fraud, a report published Thursday by the AARP Fraud Watch Network found.

The network, established in 2013 to help promote fraud prevention, commissioned a study late last summer that included telephone interviews with 200 known victims of investment fraud and 800 interviews with members of the investing public.

Doug Shadel, lead researcher for the network, said that relatively inexperienced people often invest money on their own these days, in part because of the decline in traditional pensions. At the same time, he said, technology makes it easier for scam artists to reach larger numbers of people, by telephone or email.

The report sought to pinpoint traits that may help explain why some people are more susceptible to investment fraud, Mr. Shadel said. Victims were more likely to be men 70 or older, and they tended to be risk takers. About half of fraud victims agreed that they did not mind taking chances with their money, as long as “there’s a chance it might pay off.”

And nearly half of fraud victims, compared with less than a third of general investors, agreed that “the most profitable financial returns are often found in investments that are not regulated by the government.”

Victims were more likely to report valuing wealth accumulation as a measure of success in life and being open to sales pitches, the research found.

Victims reported that they frequently received targeted telephone calls and emails from brokers and that they made five or more investment decisions a year. Also, they were more likely than general investors to respond to remote sales pitches, including those delivered in television commercials.

As many as 17 percent of Americans 65 and older report being the victim of financial exploitation, according to the Consumer Financial Protection Bureau. Estimates of annual losses are in the billions of dollars. One factor that may play a role is mild cognitive impairment, a condition that can be a precursor to dementia and can diminish an older person’s ability to make financial decisions.

Older people are at risk of being swindled not only by strangers, but also by people they know. Douglas Canada, a 78-year-old retiree in Nevada, sought help from the fraud network after he was tricked by an old acquaintance: He received a call in 2015 from a man who had been a co-worker three decades earlier. The man invited Mr. Canada and his wife to lunch to talk about an investment opportunity. The man and his date sported Rolex watches, and they even bought a diamond ring during the outing. “They really put on a good show,” Mr. Canada recalled.

The man told Mr. Canada that he had grown rich by buying and renovating foreclosed homes in another state. He invited Mr. Canada to invest, promising double-digit returns. Mr. Canada sent a cashier’s check for $40,000 — but has since been unable to contact the man. Mr. Canada has hired a lawyer and a private investigator, and he has written to the state authorities, but isn’t optimistic about getting his money back. “He’s a con man,” Mr. Canada said. “I was gullible, and I fell for it.”

Some scams — gold investing, real estate schemes, and even one involving leases on A.T.M.s — may sound improbable after the fact, Mr. Shadel said, but victims report being persuaded — sometimes, because of word of mouth from friends or family.

Recognizing that you may have a predisposition toward risky behavior, like being open to pitches, may help you avoid being taken in, Mr. Shadel said. “You can at least be aware of your psychological mind-set,” he said. Consumers can take a quiz, based on the study’s findings, on the fraud watch website.

Mr. Shadel urged consumers to deal only with regulated brokers and investments, and to “ask and check”: If you get a call from a broker, ask if he or she is registered with state and federal securities regulators, he said, “and then check to see if it’s true.”

You can check a broker’s background though Finra, the Financial Industry Regulatory Authority, using its online BrokerCheck tool at www.finra.org, or by calling 800-289-9999.

Maggie Flowers, associate director for economic security with the National Council on Aging, said that older people should be skeptical of any offers, particularly unsolicited ones. “Always ask for things in writing,” she said, “so you can think it through and talk through the options with a loved one or peers.”

Here are some questions and answers about older people and fraud:
Are older people at risk for fraud only if they are wealthy?

No, Ms. Flowers said. Scam artists know that many older people have fixed incomes, which may make them vulnerable to fraud because they are open to hearing about ways to make money and pay their bills.

Where can I learn more about protecting an older person from fraud?

The National Council on Aging offers tips on avoiding fraud at EconomicCheck.org.

The Consumer Financial Protection Bureau offers a “Money Smart” guide for older adults, and other resources, on its website.

What should I do if I think an older person has been a victim of financial fraud?

You should report it to the local police, and your state attorney general’s office.

You can also contact your local adult protective services agency. You can find a local agency that investigates reports of financial exploitation on the federal Eldercare Locator website or by calling 800-677-1116.

The Justice Department also offers an online “elder abuse resource road map.”

Complete Article HERE!

When You Love An Old Dog, Managing Care Can Be A Challenge

By Preeti N. Malani

The notion of dog years stems from the common belief that one year for a dog equals seven years for a human. Although canine aging is more nuanced than a simple formula, any dog lover knows that dogs’ lives pass far too quickly.

Even so, America’s 70 million dogs, like their human companions, are living longer, on average, because of better medical care and nutrition. Caring for elderly dogs can be heart-wrenching. Many pet owners struggle to understand when to pursue aggressive care and when to stop and help a beloved pet pass on.

“Older patients are the biggest challenge veterinarians face,” says Dr. Alicia Karas, an assistant professor of veterinary medicine at Tufts University. She argues for a holistic approach to older dogs, saying that “too often we focus on the affected body part or the results of an X-ray, not how an animal walks into the exam room.”

Pain tops the list of common health concerns for older dogs, with causes ranging from the routine, such as arthritis, to the more serious, such as cancer. As in humans, pain management can be complicated by other conditions. A dog with weak kidneys, for instance, may not be able to take common medicines like ibuprofen.

The benefits of a good rehabilitation program can be far-reaching. Older dogs may not make it outside for long walks, says Karas, but with rehabilitation, “three times a week the dog gets out and sees people who pet and love him.”

Older dogs, like their aging owners, may experience memory loss. “When we work up a pet for urinating in the house, we tend to focus on the kidneys, bladder and endocrine reasons,” she says. But it may be a case of “simply forgetting to go to the bathroom,” she explains. Anxiety is closely linked to impaired memory, and even minor changes in the household can be hard on older dogs.

While specialized care may seem ideal, Dr. Stephen Steep, a veterinarian in Oxford, Mich., tries to present a menu of options and to set realistic expectations of what can and can’t be done. “Here are some things you can do. If cost is not an issue, this is an option,” he says. “Here is another less aggressive option.” But the pet’s comfort is paramount, and Steep says he always considers whether or not a particular decision will improve quality of life.

When it comes to end-of-life discussions, Steep recognizes they’re inherently difficult. He likes to start with open-ended questions, noting that many owners aren’t aware of subtle changes. “How is your dog’s appetite?” he asks. “Is your dog sleeping through the night? How is he doing on long walks?”

Although Steep believes most owners understand there is a limit to their pet’s life, he feels people don’t always realize how old their pets really are. He tries to help them accept aging as a normal process, not a disease.

“People want to have dog pass away at home in their sleep, but that is rarely the case,” Steep says. “You get into a situation where the pet cannot go outside to urinate or defecate. He may be gasping for air due to heart failure or incapacitated due to memory loss.”

Still, some people just can’t let go. When Steep gets the sense that someone is pushing too hard, he tries to emphasize the pet’s comfort. “I’ll pull them into clinical activities like checking heart rates, monitoring water intake, to try and open their eyes,” Steep explains.

Most owners come to the realization that their dog is at the end of its life.

Although Karas recognizes the moral distress created by end-of-life decisions, she acknowledges the importance of euthanasia. “When I have no other options, I have a tool to alleviate suffering.”

When Andrew Shepherd’s 14-year-old English setter, Madison, developed seizures, he focused on maintaining her quality of life. Given her age and the lack of any obvious discomfort, Shepherd decided against an extensive work-up and instead focused on the dog’s symptoms, a decision their veterinarian supported.

During the following months, the seizures become more frequent, lasted longer and the dog appeared to be in pain. “She would yelp,” Shepherd recalls. “It was clearly not a pleasant experience.”

One day Madison suffered a protracted seizure while traveling in the back seat of Shepherd’s car. For him, this was the tipping point. “We couldn’t sacrifice her quality of life just to keep her around,” Shepherd explains. After that, it was about selecting the right moment to let Madison go.

Their final night together was a celebration of Madison’s life. The family comforted their dog, took pictures, shared their favorite Madison stories and made a list of all the nicknames they had for her.

Shepherd recalls crying as he took Madison to the veterinarian’s office for the last time. “Normally she hated going to the vet, but this time she didn’t fight at all,” he says. “She knew it was time.”

Complete Article HERE!

Exploring death through the isolation of VR

Confronting your own mortality is tough but helpful.

By Mona Lalwani

[I]’m sitting on a field of tall, red grass staring straight ahead at a lone tree. Its leaves match the crimson landscape that stretches out before me. In the distance, a rusty orange forest fades into the background. There’s a gentle rustling of leaves, occasionally interrupted by the faint chirping of a bird, that forces me to breathe slower.

“Thank you for being here and being willing to consider moving towards the idea of dying and death,” a calm, male voice prepares me for the virtual meditative journey.

A hazy white light source rises in the distance as the voice walks me through the process of focusing on my breathing. I watch the blades of the grass swish to the left with the wind. The tree slowly starts to lose its leaves. “Feel the air around you,” the voice continues. “Feel yourself letting go as if you’re a tree dropping your leaves. The breeze takes the leaves away. Everything that you know and everything you cherish will be taken by the wind.”

As I let the weight of those words sink in, the blue sky slowly takes on a deep green hue, ushering in darker skies. Within moments, the field beneath me turns into a deep red lake that starts to rise around me. I gasp for air before I quickly remind myself that I have an Oculus Rift headset on my face.

When We Die is a virtual reality experience for perhaps the most difficult kind of contemplation: the end of life. The first half, with the metaphorical tree, presents the ephemerality of nature as a symbol of the finiteness of your own life. But the next chapter addresses the wider perception of death as a tragedy through real-life experiences.

In the second half, serene views of the cosmos shift the narrative from considering your own mortality to thinking about the process of dying as an inescapable reality for all. Celestial objects that dot the night sky reveal audio clips from a hospice worker, who shares her observations of death, and a neurologist, who grounds the experience in a physician’s approach to it.

“We wanted to create a safe space for people to have difficult conversations,” said Paula Ceballos, an NYU student who is a part of a trio that created When We Die for the school’s Interactive Telecommunications Program. “We find that in the Western culture death and dying and aging get put behind closed doors, and we wanted to bring it up and make you think about it.”

The fear of death, your own or a loved one’s, is deeply ingrained in the human psyche. It can drive the choices we make, yet it continues to be shrouded in mystery. Over the years, hundreds of research studies have probed the process of dying, the fear of confronting death and how the awareness of one’s own mortality has impacted religious, cultural and spiritual world views.

When We Die makes room for that spiritual contemplation with its abstract worlds: There are no physical bodies, only metaphors for the process of aging and dying. But the idea is rooted in a more practical understanding of the ways in which neglecting end-of-life processes can hamper the process of dying, especially for the elderly and the terminally ill.

“It leads to systemic challenges,” said Leslie Ruckman, an NYU student whose background in health care informed her work on When We Die. “There’s all this money that gets spent on treating patients in ICUs, and people [often] end up dying in hospitals even though advance directives might say they’d rather die at home. These are bigger issues that arise out of the inability to look at the end of life and not being able to define what a good death might look like.”

The VR experience relies on surreal visuals to make that happen. According to co-creator Dana Abrassart, when the group first started working on the project, they envisioned a James Turrell-style liminal space. But they quickly realized that a virtual take on the light and space movement would trigger motion sickness.

Nausea in a death-related experience would defeat the purpose of their work. So instead, the group found inspiration in Richard Mosse’s infrared imagery. “It’s this idea that there’s a light spectrum around us but the human eye can’t see it,” Ruckman told me. “We liked that as a parallel to this natural process that is always present and yet, we choose not to see it.”

Death is a constant. Yet its prevalence is hidden behind hospital doors. “In the US, there’s a sanitization of death,” Dr. Gayatri Devi, the neurologist whose voice floats through the cosmos in the second half of the VR experience, told me at her clinic in Manhattan. “Our current view of death might be a victim of industrialization and development. There’s less contact with ill people who are dying so they get sequestered and put in a different place. Whereas in India, for example, there is a philosophy of maintaining contact with family and contact with death is not uncommon.”

More than 80 percent of Americans with chronic illnesses would prefer to forego hospitalization, but according to the CDC, 70 percent of that population dies in a hospital or nursing home. Even in cases where patients have advance directives to avoid aggressive measures, a widespread study revealed that only 25 percent of the physicians were aware of their patients’ end-of-life choices. The discrepancies are jarring. Even though the rise of palliative care and hospice work in the past few years is starting to close that gap, the inability to talk about death continues to get in the way of making better choices.

“Death is not a contagious illness,” said Dr. Devi. “But in some ways, we treat it like one. We need to talk about it and get comfortable around it and maybe use VR to experience it. The better the conversation about death, the more likely we’ll be to allow more of us to die at home so we’re not scared of it.”

Conquering those fears has been the focus of recent psychological explorations in VR. While When We Die uses a light meditative touch to approach conversations around death, a Spanish research group recently simulated an out-of-body experience to tackle the full spectrum of thanatophobia (or the fear of dying) in an attempt to reduce anxiety.

“Death is not a contagious illness. But in some ways, we treat it like one. We need to talk about it and get comfortable around it and maybe use VR to experience it.” — Dr. Gayatri Devi

The idea of one’s own nonexistence has always been a tough one to conquer. “But it’s a reality and we can’t opt out of it,” said Dr. Devi. “When you allow yourself into that space of thinking you’re dead, where you lose agency over yourself — that can be a powerful experience. Allowing yourself to sit with that makes you vulnerable and to be able to think about death. You have to allow that to happen.”

While some might consider this exploration of death terrifying or even futile, in many cases the practical rewards offer the required motivation. Preparing beforehand, for instance, allows people to get their affairs in order, which unburdens families from making end-of-life decisions.

“When people are faced with death, if they haven’t done any preparation, there’s too much fear and anxiety to let anything else in,” Stephanie Hope, the hospice nurse who shares her experiences in When We Die told me. “It makes it important to talk to people who aren’t faced with that yet.”

Hope, who has been a hospice worker for about four years, points out that when people think about having limited time, they start to withdraw and often show an inclination to spend time with people they’re close to. She likens that purposeful shrinking of the world to a kind of intimacy and peace that can be felt in the aloneness of VR.

The isolation, which tends to be one of the biggest criticisms of the medium, lends itself to the deeply personal experience of contemplating death. “You’re in your own world and this is your moment,” said Hope. “So to think that that’s what it might be like at the end for you can be powerful thing.”

While the immersive possibilities of VR feel contemporary, tools that address the human predisposition to death have been around for centuries. John Troyer, director of the center for death and society at the University of Bath, traces the lineage of the visual format all the way back to mediumship. “For me, a lot of it, although a different kind of technology, has a relationship to this idea of connecting with the dead in some way,” he said. “To understand any kind of new tool that is supposed to help people think about death, we have to place it in context of the long history of tools that were created by humans to help other humans make sense of their mortality.”

Troyer pointed to theatrical experiences like phantasmagoria of the 19th century, which played with themes of monsters and death long before VR. The use of projection systems like magic lanterns turned those imaginative ideas into visual experiences for audiences, which in a way is comparable to the current applications of the immersive technology.

The visual trickery of present-day VR, however, is far more profound than its predecessors, both in terms of the visual display as well as its potential for real-world impact. Death-related VR experiences can help prepare people for the inevitable but can also be used to train hospice nurses. Hope believes that bringing VR headsets into nursing school simulation labs, where trainees already work with dummies to stage scenarios, could provide crucial insight into hospice work from a patient’s perspective.

While hospice workers are trained to care for the dying, physicians are primed to prevent death. “In medicine we’re taught to keep that heart beating,” said Dr. Devi. “There’s an attitude of ‘let’s do whatever we can to keep this person’s heart beating, even if that doesn’t improve their quality of life.’ But why are we putting our elderly or very ill patients through these aggressive ways when the outcome is not going to be a good-quality life?”

When We Die doesn’t address those questions directly. Instead, it gets at them with an acknowledgement of death as a potentially positive experience. There’s an inherent belief that dying is depressing. It continues to be a terrifying unknown because we lack experience in it. But as the VR experience reveals, the tragedy of death isn’t true for all.

Complete Article HERE!

Circle of life: Former Victoria maternity doctor now helps terminally ill people end their suffering

Dr. Stefanie Green in her Victoria office this week. Green, who started her career as a maternity doctor, has provided medical assistance in dying to 25 people over the past eight months, people who want to depart this life on their own terms in the face of painful and imminent death.

By Randy Shore

For Stefanie Green, the transition from baby doctor to helping people die was completely natural, providing care at different ends of life’s continuum. 

“I (originally) chose maternity and I liked the fact that it was happy medicine, and really I can’t think of a better job on the planet than delivering babies,” she said. “I was in in my 20s when I started, so it felt (like) really familiar territory because I was also getting married and having kids.”

But helping people to die is not so different when the dominant emotion is not sadness, but gratitude.

Green has provided medical assistance in dying to 25 people over the past seven months, people who want to depart this life on their own terms in the face of painful and imminent death.

“The overwhelming emotion in the room when I provide this care is relief and gratitude,” said Green, a Victoria-based physician with 20 years experience in maternity care. “There is a release from suffering. The family is overwhelmingly grateful. The patient is overwhelmingly grateful.

“There is a real satisfaction on the part of the patient, who has made an empowering decision and been able to fulfill it after years of pain and hopelessness.”

Death review panel

About 200 people in British Columbia have opted for a medically assisted death since last June 17 when Bill C-14 created a legal environment for assisted dying. More than 740 Canadians died with medical assistance in 2016.

With six-plus months of data now in hand, the B.C. Coroner’s Service — with representatives of the health regions and the provincial government — plans a Death Review Panel for later this month to assess the new process. A report will be made public later this year.

As a young doctor, Green took careful note of celebrated B.C. right-to-die cases, including the 1994 death of Sue Rodriguez and, more recently, the 2012 B.C. Supreme Court decision that would have allowed Gloria Taylor the right to end her life. But it wasn’t until Green took a break from her maternity practice two years ago that she considered changing the focus of her career.

“When I realized that our laws were truly about to change and there was an opportunity to work in this new field I really began to educate myself,” she said.

There is a release from suffering. The family is overwhelmingly grateful. The patient is overwhelmingly grateful’ — Stefanie Green, provider of medical assistance in dying

After attending the 2016 conference of the World Federation of Right to Die Societies in Amsterdam, Green felt sure of her new course.

“Talking to people in the field, they were talking about choreographing the death,” she said. “Everything I heard sounded a lot like preparing for a birth. I really saw how those skills were going to be transferrable from one to the other.”

“There’s an art to making sure everything is going as smoothly and safely as possible during a delivery while still understanding you aren’t the most important person in the room,” she said. “I find that is the skill I take the most with me to end-of-life care.”

Public demand

The new law appears to have tapped public demand, as almost one person per day receives medical assistance in dying in B.C. 

“When people come to me they have made a decision that they want this service,” said Green. “People are decided, courageous and very determined. They’ve made the leap.”

But not everyone who wants a medically assisted death can get it.

The federal law includes a criterion not found in the B.C. Supreme Court ruling, namely that the patient’s natural death “has become reasonably foreseeable.”

“It’s not exactly clear what that means,” said Green. “For someone who can’t make a clear case, it’s a difficult box to tick. I’ve had to say no to people and it’s the hardest part of the job, but I need to work within the law.” 

The vast majority of Green’s patients are in the terminal stages of cancer and many of the others are in end-stage failure of the heart, liver or lungs. Most remain lucid right to the end, and importantly able to consent or decline the procedure to their final moments of life.

With some neurodegenerative diseases, the accelerating loss of mental capacity can muddy the waters.

“When people come too late in the course of their disease, it’s a problem,” she explained. “It may be that they are well enough to make the decision when I meet them, but they decline so quickly that they become confused and we have to stop the process.”

MAiD becoming normalized

Green is convinced many people will come to view medical assistance in dying — MAiD for short — as it becomes a normal part of medical care in a continuum that includes prenatal and preventative care, aggressive therapy for illness, hand-holding when treatments aren’t working and palliative care for those who seek comfort at the end of their lives.

She is adamant that the obligation to provide care does not stop five weeks or even five seconds before death.

“MAiD is just another part of that spectrum. Some people really need to fight to the last breath and some people really need to call the shot at the end,” she said. “The Canadian public understands very well what this care is and 87 per cent of them support it. I think that’s very humane.”

Complete Article HERE!

End of life pain control important consideration

[W]oody Allen, when asked for his opinion about death, replied, “I don’t worry about dying, I just don’t want to be there when it happens!”

Unfortunately, Allen will be there and so will the rest of us. This week, I have a personal interest in the end of life.  And what can we all do to provide the best of care to loved ones near death?

Years ago I conducted a five-year battle to legalize heroin to ease the agony of dying cancer patients. Readers, at that time, sent me funds to help with costs. Finally, when heroin was legalized in 1998, $450,000 was left in the kitty, which I donated to the University of Toronto, Faculty of Medicine to establish the Gifford-Jones Professorship in pain control and palliative care. For an update of the current situation, I recently interviewed Dr. Jeff Myers, the current professor of palliative care.  

Myers and his colleagues have not been idle. Today, many doctors are being trained in palliative care. There are now more hospital beds to care for dying patients along with better symptom control. But some “ifs” remain. 

I asked Myers what was the stumbling block surrounding palliative care. He replied: “The reality is, 100 per cent of us will eventually die. So faced with this indisputable fact we must ensure we depart in the most humane way possible.”

This means total and effective palliative care for every person.

Myers reported one shocking problem. Some doctors are not providing adequate painkillers, even when patients have only a short time to live, for fear of causing addiction. This reasoning boggles my mind as years ago I heard this same asinine argument when I was trying to legalize heroin for patients in agony at death’s door.

Myers is concerned this reluctance will be compounded by the current epidemic of opioid drug deaths. Since doctors are being blamed for causing this problem by over-prescribing opioids, they may be less likely to prescribe them to dying patients. But from my research dying patients do not become addicted to painkillers when they are used for pain. Addiction occurs when drugs are used repeatedly for pleasure. So let’s stop blaming doctors for all of the opioid deaths.

Another major obstacle according to Myers is that medical students get very few hours of training in palliative care. This is concerning, given the universal need.

Today the Supreme Court of Canada and some U.S states have declared a legal right to request doctor assisted death. But we do not have a right to adequate palliative care.

The brutal truth is that for the majority of people palliative care is not an option as it is just not available. For example, today 40 per cent of cancer patients do not get palliative care during their final year of life. And, in some areas of the country, less than half of those who die in a hospital receive palliative care.

The problem will get worse as today 80 per cent of patients being treated in palliative care facilities are suffering from cancer. Since we are an aging population the demand for palliative care centers will increase.  

Dr. Francis W. Peabody, professor at The Harvard Medical School, is remembered for saying, “The secret of caring for the patient is caring for the patient.”

There is no better example than caring for loved ones at the end of life.

So what can be done to assure we leave this planet with the least possible trauma? The primary need is to fund the training of doctors and other medical personnel in palliative care.

Like Woody Allen we’d all prefer not to be there when death occurs. But unless we quickly discover Ponce de Leon’s Fountain of Youth, you can be assured you will be there sooner or later.

Complete Article HERE!