Veteran? Terminally Ill? Want Death With Dignity? That Could Get You Evicted.

By JoNel Aleccia

[C]alifornia voters passed a law two years ago that allows terminally ill people to take lethal drugs to end their lives, but controversy is growing over a newer rule that effectively bans that option in the state’s eight veterans’ homes.

Proponents of medical aid-in-dying and residents of the Veterans Home of California-Yountville — the largest in the nation — are protesting a regulation passed last year by the California Department of Veterans Affairs, or CalVet, that requires that anyone living in the facilities must be discharged if they intend to use the law.

That’s a position shared by most — but not all — states where aid-in-dying is allowed. As more U.S. jurisdictions consider whether to legalize the practice, the status of terminally ill veterans living in state-run homes will loom large.

“It would be a terrible hardship, because I have no place to go,” said Bob Sloan, 73, who suffers from congestive heart failure and other serious cardiac problems. He said he intends to seek medical aid-in-dying if doctors certify he has six months or less to live.

“I’m not going to be a vegetable,” said Sloan, a Vietnam War-era veteran who moved into the Yountville center five years ago. “I’m not going to end up living in so much pain it’s unbearable.”

A CalVet official said the agency adopted the rule to avoid violating a federal statute that prohibits using U.S. government resources for physician-assisted death. Otherwise, the agency would jeopardize nearly $68 million in federal funds that helps run the facilities, said June Iljana, CalVet’s deputy secretary of communications.

California is not alone. Three other states where aid-in-dying is legal — Oregon, Colorado and Vermont — all prohibit use of lethal medications in state-run veterans’ homes.

In Montana, where aid-in-dying is allowed under a state Supreme Court ruling, officials didn’t respond to multiple requests about whether veterans would be able to use the law in the residences. However, Dr. Eric Kress, a Missoula physician who prescribes the lethal medication, says he has transferred patients to hospice, to relatives’ homes, even to extended-stay hotels to avoid conflict.

In Washington, D.C., where an aid-in-dying law took effect last summer, the Armed Forces Retirement Home won’t assist patients in any way. Those who wish to use the law would be referred to an ethics committee for individual consideration, spokesman Christopher Kelly said in an email.

Only Washington state has a policy that allows veterans to remain in government-run residences if they intend to ingest lethal medications.. At least one veteran has died in a state-run home using that law, said Heidi Audette, a spokeswoman for the state’s Department of Veterans Affairs.

Paul Sherbo, a spokesman for the U.S. Department of Veterans Affairs, said the choice is up to the states.

“VA does not mandate how states comply with federal law,” Sherbo said in an email. “There are a number of ways individual states can choose to handle such situations and still be in compliance.”

To date, none of the 2,400 residents of California’s veterans homes has formally requested medical aid-in-dying, said Iljana. That includes the more than 900 residents of the Yountville center, located about 60 miles north of San Francisco.

“We would respectfully and compassionately assist them in transferring to a hospice, family home or other location,” Iljana said in an email. “We will readmit them immediately if they change their minds.”

But Kathryn Tucker, executive director of the End of Life Liberty Project, an advocacy group that supports aid-in-dying, said that CalVet is interpreting the federal regulations too broadly and denying terminally ill veterans the right to choose a “peaceful death” through medical assistance.

“Nothing exists in the federal statute’s language that would prohibit a resident from receiving aid-in-dying services at state homes, so long as they are not provided using federal funds or employees,” she said.

Ed Warren, head of the Allied Council, a group representing veterans at the Yountville site, co-signed a letter to CalVet officials protesting the ruling.

“My point of view is that it is inhumane to expect people in the last stages of dying to go through the hullabaloo of leaving their homes,” he said.

In Washington state, a 60-year-old man diagnosed with terminal chronic obstructive pulmonary disease, or COPD, died in June 2015 after ingesting lethal drugs at the Washington Soldiers Home in Orting, where he lived.

“It was all done very much in the open,” said Chris Fruitrich, a volunteer with the group End of Life Washington, which assisted the man.

There has been no indication that the policy jeopardizes the nearly $47 million the agency receives each year in federal funds, said Audette, the state VA spokeswoman.

In California, additional protests have centered on allegations that CalVet suppressed information about the aid-in-dying law.

Critics at the Yountville home contend that CalVet passed the discharge rule quietly, with little public input. Then the agency refused to broadcast a public meeting about medical aid-in-dying on KVET, the center’s state-run, closed-circuit television station.

Iljana said the Aug. 21 meeting, led by Tucker and Dr. Robert Brody, also a supporter of aid-in-dying, violated state rules that prohibit using public resources to promote political causes.

“Free speech is great and criticizing the government is great, but not using the government’s own resources and paid staff to advocate for a change in the law,” Iljana wrote in an email to prohibit the broadcast.

That decision, however, prompted Jac Warren, 81, who has been KVET’s station manager for eight years, to resign last month in protest, citing censorship.

“What is at issue is whether a state may completely suppress the dissemination of concededly truthful information about entirely lawful activity,” Warren wrote in an email to CalVet.

The hour-long meeting, attended by about 50 people, was not propaganda, Tucker said, but “an educational event with information provided by an attorney and a physician who both specialize in their respective fields in end-of-life care.”

Bob Sloan, who works as an engineer at KVET for a $400 monthly stipend, disagreed with the decision not to broadcast the meeting on the system that serves residents of the Yountville home.

Sloan said he knows other residents who would like to be able to use California’s aid-in-dying law if their illnesses progress.

“The only other option that people have in this state is committing suicide,” he said. “If I can’t find some way of doing it legally, I’ll do it illegally.”

Complete Article HERE!

Grieving the death of a spouse/partner

[T]he death of a spouse or partner can be one of the most devastating events in a person’s life bringing with it it’s own particular difficulties. As a result of this death you may have lost your life’s partner, lover, confidante, father or mother of your children, breadwinner, home-maker and possibly your best friend. You may be forced to make more changes than from any other event you will ever experience.

Even if you maintained a great deal of personal independence within your relationship you can be surprised and frightened to discover just how ‘dependent’ you have been on your partner. Over the years you may have related closely to one another’s fears and joys so that when one dies you feel incomplete. Your life has lost its structure and its purpose. You may be left with many unfulfilled needs – emotional, physical, practical, intellectual and social. It is hard to imagine all the areas of life your spouse once filled until you experience the gaps.

Grieving, in itself, is emotionally and physically exhausting. When you have the additional burden of taking on the roles that were previously performed by your partner, going on living may appear to be just too much. New tasks should be embarked on slowly with as much help as is available. Major decisions should not be taken when vision is clouded by anxiety and panic.

Friends may avoid social contact with you because of embarrassment. You are now a single person. Some may see you as a threat to their relationships. You may feel isolated, no longer part of a group, not invited out, or you may exclude yourself as you feel uncomfortable without your partner. Many surviving partners experience the unwanted sexual advances from those whom they counted among their or their partner’s friends.

The feeling of loneliness can be overwhelming and will probably come to you at your most vulnerable times – at night, weekends and holidays. Plan for this – at night keep the radio on, change your routine. Plan a project or outing for a weekend or holiday. Make contact with another lonely person.

Financial difficulties may arise – especially if your spouse or partner died without making a will. You may not be aware of your financial state and even if matters are in order there is often a delay in getting things sorted out. If there is a reduction in income the effect on your standard of living may cause family problems especially when children’s expectations also have to be adjusted. This can add to feelings of fear, anxiety and anger. Your local Citizens Information Centre may be of help with practical matters.

Sexual loss. The loss of love making which included touch, warmth and sharing a bed with your partner can be very painful. It can be tempting to succumb to sexual advances from another. However, such action based on acute need and deep grief is potentially hazardous. Until you have let go of the past, it is better not to make a commitment to someone new.

If your partner dies in the early years of the marriage / relationship not only do you grieve the loss of a beloved person but also the loss of a new, exciting romantic relationship with the prospect of years of mutual love and companionship. You may also grieve the hope of parenting a child or more children together. You may feel that you are the only one of your generation who has been cheated out of hopes for the future. Young widows and widowers may also be expected to comfort the parents of the dead partner.

If the death occurs in your mid-life years you may have the additional stress of feeling trapped by the total responsibility for all the many needs of teenage children which can also prevent you from expressing your own grief. The agency ‘Parentline’ can be helpful in assisting with parenting problems. At this time you may also feel a loss of identity especially if you have no interests or work outside the home.

For the elderly bereaved – the loss of a life’s partner can cause increased trauma, create health problems and may affect your will to live. Sometimes, with the best of intentions, adult children may smother the surviving parent with care and attention. They do not allow you space to grieve or to make your own decisions. If your family are far away you can feel all alone and may even feel abandoned.

For those in same sex relationships there may be added difficulties. The relationship may have been ignored or denied by the family of one or both partners. This can create added stress for you in the grieving process. As the surviving partner, you may find yourself excluded from decision-making concerning the funeral and burial. You may even be precluded from attending.

Perhaps work colleagues and the wider community may just think that a ‘friend’ has died, but you have lost your life partner and companion and you have to keep your grief hidden. This intensifies all aspects of the grieving process, leading to strong feelings of loneliness, isolation, anger and, at times, frustration. If the death has been from Aids, this can lead to further social isolation. It is important that you can find someone to whom you can unburden your feelings.

Whatever your age when you are bereaved, your feeling and reactions will be influenced by the nature and duration of the relationship. If the relationship had been ambivalent, feelings of relief, regret and guilt can be confusing. It is important, when dealing with these feelings, to be totally honest with yourself. Put words on your feelings, voice them aloud or write them down. It is always helpful to talk about your feelings with someone who will listen in a caring and confidential way. This will help you to discover what you are feeling, why you are feeling like this and what you can do about it. Joining a support group for bereaved people may be helpful.

The Bereavement Counselling Service is there to listen and provide support as you struggle with your grief. In our modern world just surviving can be hard work. It is doubly hard to pull yourself out of an emotional trough but it is not impossible. Each time you cope with a crisis and make a major decision you will feel good about yourself. When you reach a goal you will gain satisfaction and self-assurance through your own competence. With time and effort you will recover to lead a full and rewarding life once again.

Complete Article HERE!

Doulas provide compassionate end-of-life care at North Hawaii Hospice

North Hawaii Hospice Volunteer Coordinator Bobbi Bryant developed an end-of-life doula program for volunteers earlier this year.

By Jan Wizinowich

[S]ince 1986, North Hawaii Hospice has been providing end-of-life care and support for their local community members. The in-home care by their trained staff and volunteers has eased the journey out of life and given support to family and friends left behind.

Recently, through the efforts of Bobbi Bryant, the hospice’s volunteer coordinator, training has been offered to volunteers to become end-of-life doulas, returning to old wisdom and benefits that can be derived from it.

“Caring for the sick and dying before the Civil War happened in the home. It was just a continuation of women raising children. They cared for the elders at the end of their life,” Bryant said.

But with the rise of medical technology, the end-of-life stage was taken out of the hands of the family, and the knowledge and wisdom was lost.

“People were being brought to the hospital to die, and then they were embalmed so we weren’t really caring for people at the end of life. We lost our skills,” Bryant said.

The resurgence of end-of-life doulas are a reflection of the return of birth doulas beginning in the 1970s.

“Midwives to the dying have been around for a long time. It started as a result of the resurgence of birth doulas and midwives. The model transferred to how we can care for people at the end. There was a lack of education around the dying process and when people wanted to start caring for their loved ones, there was a lot fear. The conversation around death had come to a standstill,” Bryant reflected.

Recognizing the need for doula training, Bryant attended a conference on death and dying on Maui last April.

“When I came back, I spent the next several months creating a curriculum and trained 14 people including nurses, an ER doc and health aids,” she said.

The decision to enter hospice care can be difficult, but once made it can free the family and caregiver to focus on the patient.

“If you come for hospice support early, you can have so much support. There’s so much pain and suffering that isn’t necessary,” Bryant shared.

The North Hawaii Hospice team includes a lead, general and vigil doula. Initially, the lead doula meets with the family and the patient to provide information about all the ways they can assist them, and establishes a relationship of trust.

The doula’s role is to provide non-medical comfort and to be a facilitator; both subtle and profound. On a practical level, the doula does whatever needs to be done — offering companionship, running errands, assisting with household chores, providing healthful meals and helping with bathing and personal care.

“You just be there, be grounded and love them. You need a way to get trust from people. As soon as I get there, I get my hands on them. The medicine doesn’t always help. So when they’re in a lot of pain I’m running energy with that pain and helping them to move the pain through, and helping them to relax,” said Rose Riedesel, a hospice volunteer and healing body worker.

But a primary role for the doula is to sit, listen and be aware of what’s happening with the various aspects of the patient’s care in order to act as an information conduit between the medical care team and the patient.

“The doula is an adjunct to the professional people involved. They’ll find out some information that the care team needs to know and they’ll pass that on, or if the family needs some information the doula will pass that on to them,” Bryant said.

Emotional well-being is vital to ease the dying process. A big part of the doula’s role is to encourage the patient to “talk with people about their life and find places of deep meaning; a deep connection in life, the people who meant something to them in their life, the experiences, what their passions were and what their difficulties were. It allows the person to sink into this process of dying,” Bryant observed.

Another role for the doula is to notice any unresolved issues, which can cause anxiety and tension in the patient.

“They listen in the stories for anything that’s unresolved. Sometimes you’ll hear something about a family member who needs to be forgiven. We want that person to have as much relaxation as possible in the end,” Bryant said.

The lead doula also helps the patient and family with a vigil plan that includes the creation of a peaceful space, along with a team of doulas sitting in shifts when the active dying phase begins.

“They help create a beautiful space for the dying person to be in with things such as art, quilts, photos and a certain scent. They ask, ‘Would you like something read to you? Who do you want with you? Can somebody get into bed with you?’” Bryant said.

After the patient has passed, the doula assists the family in making arrangements, and follows up with them.

“The doula assesses how to help the family at that time and backs out. In a couple of days, they give the family a call and ask to come and talk about what happened, maybe a beautiful touch or an interaction before the person actually stopped speaking,” Bryant said.

Just as with the birth process, dying is a time of loving connection.

Complete Article HERE!

Grieving My Boyfriend’s Death… with His Ex-Boyfriend

Being gay can feel isolating. So can loss. Conquer both, together.

By

[I]t’s never easy meeting your boyfriend’s exes, but it’s even harder when it’s at your partner’s funeral. So it was that I first met Donal, the love of Simon’s life. Handsome and charming, eloquent in his grief, I hated him before I even gave myself the chance to know him. While we got on fine at the wake, I had every intention of that being the only time we ever spoke.

This was made a lot harder by my decision to run the London marathon in our Simon’s name. As soon as the torrent of sweaty finish line selfies hit Facebook, Donal knew exactly why I had just run 26.2 miles, even though I’d done everything in my power not to bring his attention to what I was doing. It was about my pain, not anyone else’s.

“I wish we could have been better friends,” Donal messaged me.

“Well, we’re not the ones who are dead yet mate,” I wrote back. “So let’s Skype?”

We agreed to talk a few days later. Donal was immediately the most charming man I’d ever met. He was pleasant, complimentary, truthful, funny, and open about the fact he had felt just as alienated at Simon’s funeral as I had.

“What do you miss most about him?” he asked.

“His eyes,” I said. Donal nodded and smiled.

“I miss that ass, frankly.”

He paused, and then told me that I was the only other person who truly understood how he felt about Simon. I felt the same way: to speak to the only other person who had slept next to Simon was, perhaps, the most liberating thing in the world. Like the first time you make a Sean Cody joke with a new gay friend and realize that, for once, you’re speaking to someone who gets your shorthand.

We were both incredibly similar people—and both equally unaware of the chemsex and meth epidemic in London before meeting Simon—and both of us were trying to respond to his loss proactively. I wrote a play, he was making a film. He was helping support people he met who were in recovery, and I’d just run across half of London for Stonewall.

As we sat there, talking about our experiences with the same man, he started to cry as he told me that he wished he’d fought more for Simon to move out with him and get help in California, where the community was a lot better than it was in London.

This was not the first time Donal had told me this. At the wake, I had seen this as the most selfish opinion in the world: Didn’t I have a right to have met Simon too? This time round, less salty than I was when recently bereaved, I told him to stop being a fucking hero. Neither of us could have saved him, and we’d be arrogant to think otherwise. He smiled and told me he understood exactly why Simon fell for me.

We pledged to speak more, and we do. When Donal was back in England recently, we even popped into the bar where Simon and me—and Donal and me—had first met. Donal introduced me to the manager behind the counter, a man who I had bought pints from many times, knowing that we both had the same loss in our hearts, but had never spoken to.

“You won’t believe it,” said Donal, “but David here ran the marathon for Simon.”

The manager turned to look at me. He shook my hand. All three of us were choked up.

“Well then you’re not paying for those drinks,” he said.

Fran Leibowitz said in “The Impact of AIDS on the Artistic Community” that the crisis killed off the greatest audience for art New York had ever seen. For me, it also seems to have decimated a generation of mentors. Not just because of the body count, of course, but because of ageism in the gay community, a lack of social spaces that aren’t for clubbing, and because I’m sure we, as a generation younger, can seem uncomfortably ignorant of the defining moments of the gay liberation movement in the 20th century. Before Donal I had met nobody who could say certainly that what I was experiencing was not entirely new, and could confidently tell me when what I was feeling was important or when I was being a fucking idiot.

And this is as true for bereavement as it is for homosexuality. Both can feel incredibly isolating: many experience it, but it’s almost like everyone is speaking a different language when they try and share their stories. What Donal and I give each other as Simon’s partners is also what I was desperately in need of as a gay man: A confidante. Much-needed perspective. And an understanding that we are all part of something tough and beautiful together. And, I hope, I will give somebody else that when I’m older.

Complete Article HERE!

What terminally ill children taught this doctor about how to live

Dr Alastair McAlpine asked some of young patients what gave them joy and meaning – their answers surprised him

Dr Alastair McAlpine asked some of young patients what gave them joy and meaning. Their answers were surprising and positive.

By Alastair McAlpine

[A]s a pediatric palliative care physician, I spend my days working with children who have life-threatening or life-limiting illnesses and their families.

Although many people think of us as the harbingers of death, in reality, doctors like us aim to maximize quality of life, especially when that life is likely to be shortened. We recognize that these children are so much more than just their illness and that they are part of a family. We focus not just on their medical needs but also on their psychosocial and spiritual ones as well.

Last year, as part of my diploma in pediatric palliative care, I was tasked with evaluating the attitudes of my little patients towards life. I asked some of them what gave them joy and meaning. Their answers were surprising and positive.

In fact, they made me completely re-evaluate my relationships with friends and family. I now spend more time with the people I love and I tell them how I feel about them. I have tried to make kindness a priority in my life.

I decided to share some of the children’s responses on Twitter, to provide some perspective to the fractiousness that is so prevalent there. The response was overwhelming, to say the least (my thread has been retweeted nearly 100,000 times).

The kids were not hung up on “stuff”. What mattered were the things that we all intrinsically know are important, but often forget in the hustle and bustle of daily living. The biggest takeaway for me is that the happiest, most meaningful moments were simple ones that did not require vast sums of money or effort to attain, but instead embraced the importance of human connection. It was also surprising how frequently the so-called small things were the ones that turned out to have enormous significance at the end.

Here are the top six lessons that my little patients taught me about life:

1. Spending time with family and pets is incredibly important.

Whether talking, laughing, playing, or just sharing silence, time spent with loved ones and pets was priceless. Towards the end, the only regret many of the kids had was that they didn’t get to spend more time “with mum and dad and my big brother”.

2. Humor and laughter are vital.

Even though they were squarely facing death, these kids derived amusement from the same things that normal children do: silly antics; clumsy adults; slapstick humor. Laughing is so important for many reasons but key among them is that it reduces pain.

Finding levity in the face of overwhelming tragedy can be difficult, and some of the parents dug into unimaginably deep wells of courage to provide mirth when their hearts were breaking. One dad pulled funny faces through his tears. But it always paid off. And whether ill or healthy, children will always be delighted by farting.

3. Good stories told and read by a loved one offer inspiration.

The written word and vivid fantasies told with basic toys enabled children to create alternate realities away from the often sterile hospital environment. They were sources of inspiration to continue fighting, even when the “battle” seemed lost. After all, if Harry Potter could continue to face Voldemort, then they could defeat their own “monsters”.

Stories also allowed the children to construct a meaningful narrative to explain the often incomprehensible diseases they were so bravely facing. Many believe that our ability to create and share stories is what defines us as human beings, and these kids demonstrated that. Stories inspired, captivated and transported them.

4. Swimming in the sea, playing on the sand and eating ice cream (even on a cold day) are simple, memorable pleasures.

Children vividly remembered the simple pleasures that cost little except the effort of being truly present; the moments that may have seemed small at the time were often, upon reflection, priceless.

5. Children as young as four worried about what would happen to their parents.

Many of the kids had made peace with their fates but wanted to protect mum and dad from additional heartache. This role-reversal is surprisingly common and indicates that children are far more attuned to their bodies than we think they are. Death is the elephant in the room. Part of my job is to encourage honesty and to get everyone talking, even when it’s painful.

6. Simple acts of kindness were treasured and remembered until the very end.

Kindness, whether from the classmate who offered a sandwich or a nurse’s smile, was the virtue that made the biggest impact on the children. They loved kind people and remembered acts of kindness until the very end. The last words I heard from one little girl were: “Thank you for holding my hand when I was scared.”

None of these revelations are new or earth-shattering, but when they come from children who are bravely facing death, an extra level of profundity is added, which has prompted many (including myself) to re-evaluate just what is important with the very limited time we have. Now, if you’ll excuse me, I’m off to the beach to eat an ice cream.

Complete Article HERE!

Sitting With Silence in End-of-Life Cancer Care

Sometimes compassionate silence can be more effective than action when caring for a terminally ill person.

By

[T]he capacity to bear witness and respond empathically to a dying person’s suffering is inherent in end-of-life care. Holistic, relationship-centered, compassionate care is the hallmark of palliative end-of-life care.1 Yet, simultaneously, researchers have found medical training sometimes ill-equipped in preparing clinicians for the range of concerns and emotions expressed by dying patients and their families. Healthcare professionals report lacking skills in psychosocial and spiritual care of dying people, resulting in high levels of moral distress, grief, and burnout.1 Similarly, Tornoe and colleagues found “western society’s fast-paced healthcare environment conditions us to view death as a physiological event and a failure rather than a natural part of the human lifecycle and a second passage of a life.”

Modern medicine with its emphasis on cure frequently discovers itself struggling with an array of challenges in end-of-life care. Studies on the influence of compassionate silence in end-of-life care have indicated that clinicians’ focus solely on “doing” may actually be inappropriate at times and inhibit their ability to effectively address and meet the needs of the person who is terminally ill. A prominent theme was that the “do, fix, and hopefully cure” mandate in modern medicine may not be appropriate at the end of life and, in fact, may need to be balanced with the quality of being present with those who are suffering.1 Being “present” to patients who are nearing death therefore entails that clinicians possess a certain comfort level in terms of “sitting with the silence” and offering the “gift of presence.”

The Landscape of Silences

The research of Back and colleagues outlined 3 types of silences that can manifest between patients and clinicians in the clinical encounter: awkward, invitational, and compassionate. In regard to awkward silences, they write, “silence most often feels like it is dragging on too long when a well-meaning clinician thinks he should be ‘using silence.’ While we recognize that new skills have a learning curve before they can be performed smoothly, we also think that the problem with a directive to stop doing something is unlikely to produce the quality of silence that is actually therapeutic.”

Invitational silences are often intentional and used to evoke certain thoughts or feelings from the patient in an attempt to engender further dialogue and reflection. “The clinician deliberately creates a silence meant to convey empathy, allow a patient time to think or feel, or to invite the patient into the conversation in some way. While we recognize that these silences are tremendously valuable, we also note that these silences are often described as a kind of holding, which has a stage-setting, expectant quality,” explained Back. Invitational silence mentored by mindfulness can be effective in heightening patients’ awareness of the moment and help them observe their feelings and thoughts in noncritical or nonjudgmental ways. Conversely, mindfulness and the clinician’s ability to “quiet the mind” may also help to free one from distractions that might preclude attentiveness to the present moment. The clinician has to shift his or her thought from a narrative mode to one a patient perceives as more empathic or compassionate.

Although minor attention has been given to compassionate silences, researchers recently have taken note and underscored its significance in end-of-life care. Rooted in contemplative practices, compassionate silences encompass a way of being in the world and with the dying that cannot be contrived nor forced by clinicians. “Compassion in contemplative traditions is transmitted through a quality of mind … and is not a tool to be used with a specific set of indications and meanings,” Back explains. In another study conducted with hospice nurses and pertinent to the practice of consoling presence, Tornoe and colleagues found that embracing the silence demanded a mental shift from a focus on doing something for the patient to being with the patient. Compassionate silences, therefore, should never be understood as a means or device in which to create therapeutic relationships. The clinician’s ability to empathize and “join with” the suffering of the dying fosters rapport. Being present in the moment elicits openness in allowing our humanity to speak. Compassion for the other emerges naturally and freely from within. The ability to abide compassionately, amidst silence in end-of-life care and simply be provides depth and soul to the patient-clinician encounter. Clinicians who developed the ability to maintain stable attention and emotional balance, and are naturally comfortable expressing empathy and compassion can spontaneously achieve compassionate silences.

Conclusion

Mindfulness meditation, contemplative practices, and centering prayer are proven to help clinicians cultivate empathy and develop “consoling presence.” Although further research is needed, studies have clearly demonstrated the positive influence of these techniques in promoting a way of being and quality of mind that is crucial to end-of-life care. Whether meditative practices enhance empathic behavior is not known; however, evidence suggests that meditation has a positive effect on factors known to influence empathic mental processes.

Complete Article HERE!

Too many patients ‘die badly’ — 5 things to know

by Megan Knowles 

[W]hen states accept medical aid-in-dying practices, physicians risk becoming complicit in covering up the failures of their profession — particularly allowing patients to die badly, Ira Byock, MD, palliative care physician and CMO of Torrance, Calif.-based Providence St. Joseph Health’s Institute for Human Caring, argues in a STAT op-ed.

“Americans are rightly outraged by the mistreatment their dying loved ones commonly receive,” Dr. Byock wrote. “People deserve state-of-art treatments for their maladies as well as expert attention to their comfort and inherent dignity all the way through to the end of life. Both are necessary; neither alone will suffice.”

Here are 5 things to know about the article.

1. Although physicians do not want their patients to die, they must realize there comes a point when more medical treatments do not mean better care for patients. Additionally, patients’ family members and care givers must recognize their complicity in overtreating their loved ones.

2. In addition to causing patients unnecessary suffering during end-of-life-care, overtreating patients contributes to increased rates of moral distress, burnout, depression, addiction and suicide in physicians, Dr. Byock wrote.

3. Dying badly in the U.S. is most evident in university-based referral centers. Only 23 percent of incurably ill patients at UCLA’s cancer center were referred to hospice care before they died despite the American Society of Clinical Oncology’s recommendation for hospice care as a best practice, according to a study published in the Journal of Oncology Practice.

4. A separate study found UCLA patients with cancer regularly received excessive radiation treatments to tumors that had spread to their bones. Out of 54 patients who met criteria for single-dose treatment under appropriate clinical guidelines, only one patient was given the recommended one dose of radiation. Forty-two patients were prescribed 10 or more doses, which indicates a taxing treatment regimen.

5. To help keep patients from dying badly, medical leaders can draft public policies to fix longstanding flaws in clinical training, monitor members’ practices for indicators of quality end-of-life care, persuade hospitals to launch strong palliative care programs and work to implement regulatory reform to increase the minimum number of staff members in nursing homes while revoking the licenses of facilities that continually fail to meet residents’ basic needs, Dr. Byock wrote.

Complete Article HERE!