Medical Aid in Dying: What My Dog Taught Me

by

[H]e was sick, but it wasn’t like he was going to die anytime soon. A year ago, my dog Sierra sustained a neurological insult that left him delirious, unable to walk straight and almost entirely blind and deaf. Still, he enjoyed our loving touch, snuggling against my thigh as I watched a movie or falling asleep in my arms while being held. I struggled with these thoughts as the vet pushed the pink, fluid-filled syringe into his vein. He collapsed into my arms and let out a groan, as he had many times before. But this time, he did not get up.

I said goodbye and left him to join my parents standing in the waiting room. My father looked up at me, “Is it done?” I nodded, and suddenly, we all broke into tears. We embraced each other and talked about what a good dog he was. We told each other it was the right thing to do, that it was time. But was it? Why now?

I couldn’t help but think we were being selfish. Objectively, nothing much had changed since his suspected stroke, albeit he was undoubtedly more of a burden. We were constantly cleaning up after him, redirecting him when he got caught in a corner and paying for vet visits and medications. But the bottom line was that he still found enjoyment in life. Was the choice to put him down for our wellbeing or for his?

Health professionals and loved ones struggle with these same questions when caring for those nearing the end of life. Sierra’s decline came at a poignant time, one in which many are fighting for the right to choose death in the face of terminal illness or suffering. Currently, five states allow those with a terminal illness and a prognosis of less than six months to end their life with the help of a physician, also known as “medical aid in dying.” Canada legalized physician-assisted death in 2016, joining a small number of countries that have laws enabling this practice.

The principle behind these laws is relatively simple. People want to die with dignity, and in the process of fighting for the right to do so, they’ve ironically improved end-of-life care. As a free nation that claims to be a leader in health care, why have we not adopted this practice? While poking fun at “the land of the free,” Jim Jeffries, an Australian comedian known for his outsider political commentary, pointed out that “assisted suicide for the sick … is the biggest freedom of them all.”

Opposition to physician-assisted death comes from both the public and from within the medical profession itself. Deeply rooted societal ideals, values and norms fuel the debate. From day one, physicians take an oath to “do no harm.” Common sense tells us that healthcare professionals are supposed to help heal the sick, not to “help” them die. Furthermore, for some patients, taking one’s life goes against their religious values and/or our fundamental values as human beings. Also, many families find that loved ones nearing the end of life are often incapable of making well informed decisions due to fear, depression or the effects of disease on their mind. And so we choose life, even when death seems so near.

Despite the moral controversy, attempts have been made at giving patients the right to take control of their own death in the United States. Numerous court cases have brought the legality of this practice into light culminating in the 2006 Supreme Court case Gonzales v. Oregon. Under this ruling, the federal government failed to prohibit physicians in Oregon from prescribing drugs to help patients die, opening the door for states to legalize medical aid in dying. Organizations such as the Death with Dignity National Center have taken it upon themselves to both educate the public on end-of-life options and to advocate for physician-assisted death. Even so, there has been little done to legalize this practice in federal law.

Lawmakers took a step in the right direction during discussions about health care reform and the implementation of the Affordable Care Act (ACA). The misleadingly-termed “death panels” were a way to incentivize physicians to have discussions about end-of-life care with their patients. Unfortunately, this section of the ACA was thrown out due to political controversy. Finally, in 2015, the Centers for Medicare and Medicaid services approved regulations that allow qualified healthcare professionals to be reimbursed for providing advance care planning to patients. Still, moral and legal barriers persist, preventing patients from making the decision that is right for them.

Looking back, I am grateful that Sierra left us when he did. Choosing to put him down was not easy, but afterwards, I came to an important realization. By choosing death at that moment, we determined when, where and how he died. We chose a period when our family was home together so that we could spend quality time with each other in his last moments. This pronounced the end of our living relationship, giving us a sense of completion. We made sure that he died with us, in a peaceful environment, around those he loved instead of alone on the kitchen floor. He was able to leave the world peacefully and quietly without the suffering of a drawn out painful death that would taint our memory of his long and happy life. Sometimes, I wonder if the groan he let out at the end was a sigh of relief, a goodbye or even a thank you.

Complete Article HERE!

Many Avoid End-Of-Life Care Planning, Study Finds


People with chronic illnesses were only slightly more likely than healthy individuals to put their wishes down on paper in a living will.

By Michelle Andrews 

[B]efore being deployed overseas for the Iraq war in 2003, Army reservist Don Morrison filled out military forms that gave instructions about where to send his body and possessions if he were killed.

“I thought, ‘Wow, this is mortality right in your face,'” Morrison, now 70, recalls.

After that, his attention was keenly focused on how things might end badly. Morrison asked his lawyer to draw up an advance directive to describe what medical care he wanted if he were unable to make his own decisions.

One document, typically called a living will, spells out Morrison’s preferences for life-sustaining medical treatment, such as ventilators and feeding tubes. The other, called a health care proxy or health care power of attorney, names a friend to make treatment decisions for him if he were to become incapacitated.

Not everyone is so motivated to tackle these issues. Even though advance directives have been promoted by health professionals for nearly 50 years, only about a third of U.S. adults have them, according to a recent study.

For the analysis, published in the July issue of Health Affairs, researchers reviewed 150 studies published between 2011 and 2016 that looked at the proportion of adults who completed advance directives. Of nearly 800,000 people, 37 percent completed some kind of advance directive. Of those, 29 percent completed living wills, 33 percent filed health care proxies and 32 percent remained “undefined,” meaning the type of advance directive wasn’t specified or was combined.

People older than age 65 were significantly more likely to complete any type of advance directive than younger ones — 46 percent of older people, versus 32 percent of those who were younger. But the difference between people who were healthy and those who were sick when they filled out the directive was much smaller — 33 percent compared with 38 percent.

To encourage more physicians to help people to plan for their care, the Medicare program began reimbursing them in January 2016 for counseling beneficiaries about advance-care planning.

This study doesn’t incorporate data from those changes. But it can serve as a benchmark to gauge improvement, says Dr. Katherine Courtright, an instructor of medicine in pulmonary and critical care at the University of Pennsylvania. She is the study’s senior author.

There are many reasons that people are reluctant to sign a living will. “Many people don’t sign advance directives because they worry they’re not going to get any care if they say they don’t want [cardiopulmonary resuscitation],” says Courtright. “It becomes this very scary document that says, ‘Let me die.’ ”

Living wills also don’t account for the fact that people’s wishes may change over time, says Dr. Diane Meier, a geriatrician and the director of the New York-based Center to Advance Palliative Care.

“In some ways, the public’s lack of excitement about this is related to the reality that it’s very hard to make decisions about the kind of care you want in the future when you don’t know what that will be like,” she says.

Sometimes as patients age and develop medical problems, they’re more willing to undergo treatments they might have rejected when they were younger and healthier, Meier says.

“People generally want to live as well as they can for as long as they can,” she says. If that means going on a ventilator for a few days in order to get over a bout of pneumonia, for example, many may want to do that.

But if their living will says they don’t want to be put on a ventilator, medical staff may feel bound to honor their wishes. Or not. Although living wills are legal documents, medical staff and family members or loved ones can reinterpret them.

“At the moment, I’m very healthy,” Morrison says. If he were to become ill or have a serious accident, he’d want to weigh life-saving interventions against the quality of life he could expect afterwards. “If it were an end-of-life scenario, I don’t want to resuscitated,” he says.

If someone’s wishes change, the documents can be changed. There’s no need to involve a lawyer in creating or revising advance directives, but they generally must be witnessed and may have to be notarized.

While living wills can be tricky, experts strongly recommend that people at least appoint a health care proxy. Some even suggest that naming someone for that role should be a routine task that’s part of applying for a driver’s license.

“Treatment directives of any kind all assume we can anticipate the future with accuracy,” says Meier. “I think that’s an illusion. What needs to happen is a recognition that decisions need to be made in real time and in context.”

That’s where the health care proxy can come in.

But to be effective, though, people need to have conversations with their proxy and other loved ones about their values and what matters to them at the end of life.

They may tell their health care proxy that they want to die at home, for example, or that being mobile or able to communicate with their family is very important, says Jon Radulovic, a vice president at the National Hospice and Palliative Care Organization.

Some may opt to forgo painful interventions to extend their lives in favor of care that keeps them comfortable and maintains the best quality of life for the time that remains.

“The most important thing is to have the conversation with the people that you love around the kitchen table and to have it early,” says Ellen Goodman, a Pulitzer Prize-winning writer who founded The Conversation Project, which provides tools to help people have conversations about end-of-life issues.

Morrison says he’s talked with his health care proxy about his wishes. The conversation wasn’t difficult. Rather than spell out precisely what he wants done under what circumstances, Morrison is leaving most of the decisions to his health care proxy if he can’t make his own choices.

Morrison says he’s glad he’s put his wishes down on paper. “I think that’s very important to have. It may not be a disease that I get, it may be a terrible accident. And that’s when [not knowing someone’s wishes] becomes a crisis.”

Complete Article HERE!

How to Find Meaning in the Face of Death

By Emily Esfahani Smith

[T]he psychiatrist William Breitbart lives at the edge of life and death. As chairman of the Department of Psychiatry and Behavioral Sciences at Memorial Sloan Kettering Cancer Center in New York, Breitbart specializes in end-of-life care for terminally ill cancer patients. For many of his patients, the most pressing question isn’t when they’ll die or how painful death will be. Rather, it’s what makes life meaningful. They are in search of a meaning that cannot be destroyed by death.

Breitbart has spent the better part of his career trying to answer that question. His ground-breaking research shows that while the specter of death often leads people to conclude that their lives are meaningless, it can also be a catalyst for them to work out, as they never have before, the meaning of their lives.

When people believe their lives are meaningful, according to psychologists, it’s because three conditions have been satisfied: They feel their existence is valued by others; they are driven by a sense of purpose, or important life goals; and they understand their lives as coherent and integrated. Psychologists and philosophers say that the path to meaning lies in connecting and contributing to something that is bigger than the self, like family, country, or God.

Breitbart’s interest in meaning took root in his childhood. Born in 1951, Breitbart grew up on the Lower East Side of Manhattan. His parents, Jews from eastern Poland, narrowly avoided Hitler’s death camps. When they moved to America, they carried their memories of the war years with them. Breitbart’s childhood was steeped in that tragic past. Every morning, his mother would ask him at the breakfast table, “Why am I here?” Why, she wondered, did she live when so many others had died?

“I grew up with a sense of responsibility to justify my parents’ survival and to create something in the world that would be significant enough to make my life worthwhile. It’s no coincidence,” he laughed, “that I ended up at Sloan Kettering.”

Breitbart began working at the hospital in 1984 during the height of the AIDS epidemic. Young men his age were dying all around him. As he tended to them, “They were constantly asking me to help them die,” he said. He was also working with terminal cancer patients. “When I walked in the room, they would say, ‘I only have three months to live. If that’s all I have, I see no value or purpose to living.’” They told him, “If you want to help me, kill me.”

If death means non-existence, Breitbart’s patients reasoned, then what meaning could life possibly have? And if life has no meaning, there’s no point of suffering through cancer.

By the ’90s, physician-assisted suicide was a hot topic in Breitbart’s circles and beyond. The doctor Jack Kevorkian had helped his first patient end her life in 1990. As the United States debated the ethics of assisted suicide, other countries were taking steps toward normalizing the practice. In 2000, the Netherlands became the first nation to make physician-assisted suicide legal. Today the practice is legal in the United States in California, Vermont, Montana, Washington, and Oregon.

As Breitbart heard more stories of assisted suicide, he began to wonder what specifically was driving the terminally ill to give up on life. At the time, he was doing research studies on pain and fatigue at the end of life, so he tacked onto those studies some questions that asked his subjects whether they felt a desire for a hastened death. What he discovered surprised him.

They no longer wanted to die. Their spiritual wellbeing improved. They reported a higher quality of life.

The assumption had been that the ill chose to end their lives because they were in terrible pain. But Breitbart and his colleagues found that wasn’t always the case. Instead, those who desired a hastened death reported feelings of meaninglessness, depression, and hopelessness. When Breitbart asked patients why they wanted a prescription for assisted suicide, many said it was because they had lost meaning in life. Unlike clinical depression, which has a specific set of diagnosable symptoms, meaninglessness was more of an “existential concern,” Breitbart said—a belief that one’s life has little value or purpose and is, therefore, not worth living.

Breitbart knew he could treat depression—there were medicines and well-developed psychotherapies for that—but he was stumped when it came to treating meaninglessness. Then, in 1995, he began to see a way forward. He was invited to join the Project on Death in America, which aimed to improve the experience of dying. Breitbart and his colleagues on the project—including philosophers, a monk, and other physicians—had long conversations about death and the meaning of life, “peppered with references to people like Nietzsche and Kierkegaard and Schopenhauer,” Breitbart said. “What I suddenly discovered,” he explained, was that “the search for meaning, the need to create meaning, the ability to experience meaning was a basic motivating force of human behavior. We were not taught this stuff at medical school!”

Breitbart became convinced that if he could help patients build meaning, he could decrease their suicidal thoughts and make their lives worth living even to the very end.

He developed an eight-session group therapy program where six to eight cancer patients come together in a counseling workshop. Each session, in one way or another, helps build meaning. In the first session, for example, the patients are asked to reflect on “one or two experiences or moments when life has felt particularly meaningful to you.” In the second session, patients respond to the question “Who am I?” to tap into the identities that give them the most meaning. One woman responded saying, “I’m somebody who can be very private … [and] have been working on accepting love and affection and other gifts from other people.” In subsequent sessions, they share their life story with the group and think about the role that love, beauty, and humor played in their lives.

In the final session, the patients reflect on the part of them that will go on living even after they are dead—their legacy. That could be their soul, or it could be something they helped to create that will continue to exist—their children, a work of art, or an organization. They present a “legacy project” to the group, generally something they do or create that represents how they want to be remembered. One man brought in a woodcut of a heart sculpted into a Celtic Trinity. “This is what I will teach my children,” he said, “that there is eternal love, and that I will be there for them, far beyond my passing.”

Breitbart performed three randomized, controlled experiments on the meaning-centered psychotherapy. When he analyzed the results with his colleagues, Breitbart saw the therapy had been transformative. By the end of the eight sessions, the patients’ attitudes toward life and death had changed. They were less hopeless and anxious about the prospect of death than they were before they began the program. They no longer wanted to die. Their spiritual wellbeing improved. They reported a higher quality of life. And, of course, they found life to be more meaningful. These effects not only persisted over time—they actually got stronger. When Breitbart followed up with one group of patients two months later, he found that their reports of meaning and spiritual wellbeing had increased, while their feelings of anxiety, hopelessness, and desire for death had decreased.

The time between diagnosis and death, Breitbart has found, presents an opportunity for “extraordinary growth.” One woman, for example, was initially devastated by her diagnosis of colon cancer—but after enrolling in the therapy program, she realized, “I didn’t have to work so hard to find the meaning of life. It was being handed to me everywhere I looked.” And that realization ultimately brought her—and Breitbart’s other patients—some measure of peace and consolation as they faced life’s final challenge.

Complete Article HERE!

A New Game Helps You Navigate Difficult End-of-Life Conversations

By Michelle Woo

[C]all it the new game of Truth. Players go around the table answering questions in their little blue booklets, but these questions aren’t geared to get them talking about that one time they went skinny dipping in Maui. Instead, the questions aim to launch difficult conversations, ones that may be painful, ones they may have been avoiding for far too long.

“Who haven’t you talked to in more than six months that you would want to talk to before you died?”

“What music do you want to be listening to on your last day alive?”

“Which is more frightening to imagine: suffering the worst physical pain of your life or not getting a chance to say goodbye to your family?”

This game is called Hello, and its goal is to get people talking about end-of-life issues in a way that’s easy and non-threatening. The most revolutionary aspect of it—and it’s such a simple thing—is that everyone can and should play. (Newsflash, friends: we’re all gonna die.) So often when it come advance care planning conversations, we single out the person who is sick or elderly, and it can feel like an interrogation. That is, if we even get to the conversations at all. According to Nick Jehlen, the lead designer of the game, people are often too nervous or distraught to delve into these real, complex discussions, or they feel it’s never the right time. The talks, he says, “just don’t happen.”

Families, friends, organizations and healthcare teams have gotten together to play Hello, which is created by Common Practice, a company that promotes better conversations about living and dying well. Some of the questions were written by backers of the Kickstarter campaign for their original game, My Gift of Grace. The topics range from the logistical (“If you needed help going to the bathroom today, who is the first person you would ask to help you? Who would you never be able to ask?”) to the abstract (“What do you think happens to you after you leave this life?”). Each player gives out game chips—“thank you chips”— to other players as they feel moved to, which creates, as Jehlen describes, “an economy of gratitude” within the game.

Jehlen says,“It’s challenging, and sometimes people do cry, but what we’ve really done is create a set of structures that help people be supportive of each other. Almost every time I play with a new group, people share things they’ve never talked about before, and just as importantly, they feel good about it.” He adds, “It sounds crazy, but the game is fun.” Of people who play Hello, 75% go on to complete an advance care planning step within a few months.

Talking about our own mortality doesn’t just save others from guilt, trauma and expense down the road—these conversations can actually improve our quality of life. They help us to really narrow in on what matters to us here and now. Perhaps a game can help get the ball rolling.

Complete Article HERE!

Meet the “Death Positive” Women Changing the Funeral Industry

Courtney Lane, who practices the art of Victorian hairwork, with some of her creations.

by

[S]ooner or later, the end is coming — for all of us. But women in particular have been at the forefront of the “death positive” movement, which aims to strip away the mystery and fear around the end of life and help us each find our own “good death.”

Amber Carvaly is a mortician and service director at Undertaking LA, the funeral home she coruns with Caitlin Doughty. A women’s studies major whose life’s passion has been to work harder, better, smarter, and kinder as a human being, she soon found herself in the nonprofit industry, preparing meals and holding birthday parties for LA’s homeless. When she lost her job after the economy crashed in the late aughts, she made friends with a funeral director. “It seemed like it had similar characteristics to what I was doing at the Downtown Women’s Center,” Carvaly remembers of their talks about funeral work. She wanted to continue helping people and decided to go back to school, this time to study mortuary science. “I had been emailing Caitlin throughout this,” Carvaly says, “although we had never met.” Eventually, Doughty asked if Carvaly was interested in helping her start Undertaking LA and the rest, as they say, is death-positive history.

Amber Carvaly of Undertaking LA.

“It is not death that is important, but how we live our lives as we near it,” Carvaly explains. “How we view and treat the dead is a reflection of society and our values. What I want is to change our hearts and souls and the way we literally see and process the world around us. I think our very existence and survival as a species depends on it.” Carvaly’s next big plan is to offer house death calls, where families are given a person to guide them through washing and dressing the body. “In my experience,” Carvaly says, “families have not needed anything spiritual or extravagant. They just want someone to stand with them and help give them the confidence to use the strength they already have within themselves to start.”

Melissa Unfred with her sidekick, Kermit.

The Summer before Melissa Unfred‘s senior year of high school, a local funeral home was featured on the news. They were a family-owned business looking for assistance and, as a joke, her mom turned to her and suggested she get a job. A budding rebel, Unfred did just that. “I was fascinated by the science and art involved in funeral service and embalming,” Unfred says. “And led by such a strong woman, no less! Billie White Everett [the home’s owner and one of the first female directors in Texas] made a huge impression on me.”

These days, Unfred educates people about home funerals and green burial, which focuses on returning the body to the earth in its natural state by foregoing embalming and using biodegradable materials like wooden caskets. She partners with an Austin crematory that shares her core values and is one half of Texas’s first certified therapy dog team working in funeral care, along with her furry sidekick, Kermit the dog. Originally adopted to be a pet and emotional support source for Unfred, Kermit’s knack for interacting with others, particularly the grieving, quickly became apparent. Now, the two are inseparable during transfers to funeral homes after someone has died, at graveside ceremonies, and everywhere in between. Together, they’re on a mission to clear out the smoke and mirrors of the funeral service, helping families understand their options so they can make an informed decision on what they want for themselves and their loved ones.

One of Lane’s hairwork pieces.

Courtney Lane of Never Forgotten braids hair for a living. She’s following a tradition called “hairwork,” which was part of the extensive Victorian mourning process. “What really makes hair art and jewelry special is that it can contain the hair of your loved ones,” Lane says. Her clients might provide her with their own hair to make into a romantic gift or a snippet from their child’s first haircut. Lane also works with cancer patients who lose their hair during treatment. “A cancer survivor once explained to me that this was an artistic statement that helped her feel like she wasn’t losing her hair, but transforming it into something new and beautiful,” Lane says. Very often, of course, the hair she’s working with is that of a deceased family member; because hair doesn’t decompose, Lane explains, it’s a perfect relic with which to remember our dead.

In addition to custom work for clients, Lane also makes art out of antique Victorian hair and travels to give lectures and workshops on the misunderstood history behind hairwork and its elaborate techniques. The first time she showed her art at a convention, a man walked up to her table and asked, in what she calls a Disney villain voice, if she could make him “something truly evil” if he brought her the hair of his enemies. Since then, she has gotten so many similar requests that she added a section to the FAQ on her website. The answer is no.

The theme of education runs throughout the work of Lane, Carvaly, and Unfred. For while death is ubiquitous, it is also misunderstood and maligned. “I do completely believe that humans should not be afraid of dead bodies,” Carvaly says. “By leading by example, I can show others that there is another way to approach our existence and demise. And that if I can do it, so can they.”

Complete Article HERE!

Prehistoric Britons ate the dead & carved their bones – research

Prehistoric cannibals who once lived in a Somerset cave engraved human bones with zig-zag designs as part of a “complex” eating ritual, according to new research.

The bones, which had a number of deliberate cuts and human teeth marks, were discovered at Gough’s Cave in the Mendip Hills and are believed to be between 12,000 and 17,000 years old – when the cave was occupied by Ice Age Britons.

Scientists from the Natural History Museum in London and University College London (UCL) compared hundreds of cut-marks found on human and animal bones in the cave. They discovered one human body with the bones separated, filleted, chewed and then marked with a zig-zag design, before it was finally broken to extract the bone marrow.

Researchers ruled out an initial theory that the marks were made during the butchery process, because they were found on a part of the bone with no muscle attachments. There is no indication on the skeletons that the humans had suffered violence before they died.
They concluded that the “zig zagging incisions are undoubtedly engraving marks, produced with no utilitarian purpose but purely for artistic or symbolic representation.”

The study, published in the journal PLOS ONE, says the marks may have represented the “story” of the victim’s life or a memorial to how they died. Whatever the reason, researchers agree it must have been part of a ritual or ceremony to mark the person’s passing, like modern day funerary rites.

“The sequence of modifications performed on this bone suggests that the engraving was a purposeful component of the cannibalistic practice, rich in symbolic connotations,” says Dr Silvia Bello, lead author of the study.

“Archaeologists have linked the engraving of objects and tools to ways of remembering events, places or circumstances, a sort of ‘written memory’ and ‘symbolic glue’ that held together complex social groups.

“Perhaps the engraving of this bone may have told a sort of story, more related to the deceased than the surrounding landscape. It could be that they are indicative of the individual, events from their life, the way they died, or the cannibalistic ritual itself.”

Gough’s Cave was first discovered in the 1880s and frequent excavations at the site found evidence that humans lived there for thousands of years, including “Cheddar man,” Britain’s oldest complete human skeleton, which dates from 7,150BC.

DNA taken from the skeleton was found to match that of Adrian Targett, a man living in the local area today.

The cave is 115 meters (377ft) deep and 3.405km (2.12 miles) long, and contains a variety of large chambers and rock formations.

Human bones have been found intermingled with butchered large mammal remains as well as flint, bone, antler and ivory artefacts, including a 13,000-year-old carving of a woolly mammoth.

The team has previously found skulls at the site which had been turned into bowls or cups, possibly to eat or drink from.

Complete Article HERE!

Tidy transition can ease caring for dying parent

By Glenn Ellis

There are two things that movies consistently get wrong: sex and death. Unfortunately, as a society, we spend far too much thinking of sex, and too little time devoted to death – especially of a parent.

Caring for a dying parent is a difficult and emotionally challenging task. However, effective communication can ease the transition.

Movies consistently present death in a false or unrealistic way. Real-life death is not always dignified, simple or tidy. Indeed, death can be upsetting, messy, painful and traumatic experience for all parties involved.

Complications can arise during the course of an illness can lead to increasingly worsening circumstances. Immobile or semi-mobile patients may feel determined to walk and my try to get out of bed. As a result, some may fracture or break their hip. As bad as terminal illness is, additional complications can make quality of life worse. Patients may become restricted to their bed and may rely on a catheter.

Regardless of the attempts to prevent it, as soon as they return home, complications such as a yeast infection or urinary tract infection may occur. This causes a patient to become even more frightened and restless. How is anyone supposed to take care of a dying person? It’s a fairly straightforward to concept “nurse” a person back into good health, but how is anyone supposed to “nurse” them into death with dignity and compassion?

Then there’s the morphine. Dying parents may often feel agitated and restless, so much so that they might try getting out of her bed. The morphine may help to calm them down. Is it unethical to give it to them to address mental rather than physical pain? Although her hip fracture causes pain. Many children give their parents morphine more for their parents restlessness.

The only organ donors you see on “Grey’s Anatomy” are car accident fatalities. No one ever talks about mulling over whether or not to give someone’s organs away while they’re still conscious in another room.

These are the kinds of issues that children with dying parents struggle with every day. Many adult-children caregivers believe that their ill parent wouldn’t have wanted to live this kind of existence. They may have stated that they didn’t want a lingering, drawn-out death. This is why advance directives are so essential.

If you’re like most families (including mine), generally, the care of a dying parent falls on the shoulders (and back) of one sibling or family member. Although it’s rare for siblings to share parent care equally, it’s a family responsibility. Not treating it as such “will haunt you” later on. Even if you live far away from your ailing parent, you can still help out.

From ordering car service a couple times a week to paying bills online, anything that can be done via telephone or internet is within your reach, she notes. Just calling your mom more often “so she’s not so needy” can provide relief to the sibling carrying the heaviest load, says Russo, as can making the trip to be with your mom whenever possible, so your sibling can take time off.

End-of-life care is something that few people like to think about, let alone discuss. Avoiding the subject until it’s unavoidable, however, can be a “huge mistake” with devastating consequences for the sibling relationship. Call a family meeting when your parents are still healthy.

Such a conversation might start this way: Remember aunt so-and-so, and how our cousins were still fighting when she was on the respirator and they wouldn’t let her die and how painful that was for everybody?

We don’t want that to happen in our family.

Mom, Dad, do you have a living will? Have you assigned somebody to be the healthcare proxy? Though they may attempt to deflect such questions: nudge further. If you were on a respirator or in really bad shape, would you want us to do everything possible, or would you just want to go quietly? Who should make that decision? We’ll all want to do what’s right, but we may have different feelings.

It’s time to start an honest and open discussion of what dying really means. How can we help someone we love to pass on? What do “extraordinary measures” mean to different people? To some, it may mean CPR. For others, it might mean giving any medications that can help. Furthermore, what constitutes a tolerable living standard? For instance, what happens when someone is bedridden or unable to control their bowels?

There are few things more difficult than saying goodbye to a dying parent. These questions are undoubtedly tough ones. In most cases, they’re mentioned far too late.

Complete Article HERE!