How These Med Schools Are Improving End-of-Life Instruction

It’s a shift toward care based on who the patient is and what he or she wants

By Bruce Johansen

While all medical students must witness a birth, being present for someone who’s dying is not a requirement. Dying has traditionally received little attention in medical school curricula. Interviewed by The Boston Herald earlier this year, Dr. Atul Gawande, surgeon, founder of the Massachusetts Coalition for Serious Illness Care and author of Being Mortal (also a Next Avenue Influencer in Aging) said his end-of-life training amounted to one hour of discussion during his first two years in medical school. He’s now part of an innovative effort to improve education about end-of-life care at Massachusetts’ four medical schools: Harvard University, Boston University, Tufts University and the University of Massachusetts Medical School.

What Matters Most at End-of-Life

“We’ve been wrong about what our job is in medicine,” Gawande writes in Being Mortal. “We think our job is to ensure health and survival, but really it is larger than that. It is to enable well-being.” Gawande emphasizes training students to discern what gives a person’s life meaning and then choosing a course of treatment based on what that information involves. It’s a shift away from a “fix-it” mentality, which focuses on prolonging life.

Gawande credits the transformation in his thinking to observing palliative care clinicians and geriatricians. On an episode of PBS’ FRONTLINE, Gawande explained that seeing his colleagues’ conversations with their patients taught him what he could do better for his own.

One of those colleagues, Dr. Jennifer Reidy, is chief of palliative care at UMass Memorial Medical Center in Worcester, Mass. and a University of Massachusetts Medical School professor. “What’s great about palliative care is that you can incorporate it into your practice no matter what specialty you are,” Reidy says.

Holding conversations about what matters most and “being able to treat people’s pain and other distressing symptoms that affect their quality of life are all things that any doctor should be able to do in their field,” she says. Reidy foresees eventual changes in training extended to entire care teams: nurses, nurse practitioners, social workers, chaplains and pharmacists.

Reidy was one of the first students to do a palliative care rotation during her training at University of Vermont’s Larner College of Medicine in the late 1990s. There she learned that the care plan should be driven by who the person is, not by the available technology or what was possible.

If a person is diagnosed with an incurable disease, she says, the essential question comes down to: How do you make the most meaningful use of whatever time remains?

According to Reidy, this often means “focusing on being with the people who they love, and being more in their ‘real lives,’” rather than in the hospital. Given the option to forego harsh, life-prolonging therapy, many take care of things left undone such as making amends or getting financial affairs in order.

“It’s so unique to whatever is meaningful for that person,” Reidy says.

Fired Up Students

While details of the curricula will look different, Reidy says students at each participating school will be taught complex communication procedures for breaking difficult news and having conversations about prognoses and end-of-life planning.

When it comes to communication, “no one gets a pass anymore,” says Reidy. What’s exciting to her is that students are fired up about these developments. “It really taps into their sense of meaning and purpose, and why they came into medicine in the first place,” she says.

Students are learning how to share information in chunks and in clear language, then to pause, listen, allow questions, allow silence, allow emotion and sit with someone’s sadness or anger.

“Then they’ll be able to figure out amidst all of this, what’s most important, what should we be focusing on,” Reidy says.

To ascertain what will bring well-being, Gawande promotes students learning to ask:

• What is your understanding of your illness?
• What are your fears and worries for the future?
• What are your priorities if time becomes short?
• What are you willing to sacrifice and what are you not willing to sacrifice?
• What does a good day look like?

Instead of prompting a conversation about death or dying, these questions get to the crux of: How do you live a good life all the way to the very end, with whatever comes?

Building Momentum

Tiffany Chen, a fourth-year University of Massachusetts Medical School student, is a “champion” of the project, says Reidy. Growing up in a multigenerational home with parents and grandparents, Chen was first exposed to palliative care during her senior year of college when her grandfather was diagnosed with Lewy body dementia at the end of his life. Two years later, when her grandmother was diagnosed with bladder cancer, Reidy was assigned to be her palliative care doctor. Chen credits Reidy’s care with changing her grandmother’s course of treatment and the “quality of her death.”

Combined with a love of helping people, that experience inspired Chen to pursue a medical career. She hopes to go into family medicine and eventually have a fellowship that’s integrated in geriatrics and palliative care.

Chen has taken leadership at her school, including being part of organizing a focus group of students interested in giving palliative care “more of a voice.” The new curriculum, she says, promises to make students “better equipped at baseline to have these conversations.” They’ll become more adept at reading people’s cues and better communicators overall, “by first listening,” she says.

“The biggest thing is actually practicing with someone who’s experienced observing, and then giving you feedback,” Chen says. At her school, a simulation lab and new training methods, including role-playing patient actors, are key.

Reidy feels hopeful that the consortium is part of a larger movement, noting that medical schools at the University of Rochester and Yale University have stepped up as leaders.

Massachusetts offers a new model — the first time each of a state’s medical schools have joined forces. It’s this collaborative element that is having an impact on her school’s administration, says Chen. “Prior to this, you’d talk about palliative care being very important and needing to be in the curriculum, but that’s true of a lot of things.” The partnership has created momentum.

Complete Article HERE!

Suicide over time and across different cultures

By Dr. Phil Kronk

Is suicide a human characteristic that can never be erased?

Is there more than one kind of suicide…and more than one way to view suicide?

Has suicide been viewed by other cultures in ways different from our society today?

Tamil Nadu, in the southern region of India, has had the highest number of suicides for decades. Over 135,000 individuals killed themselves in a recent year.

The ancient Vikings hoped to someday be admitted to their paradise called Valhalla. Only violent death in battle or suicide could bring you to the heavenly halls of Valhalla. All else were denied entrance.

A form of assisted suicide, which caused death by abandonment, is called senicide. Prior to 1939 and only under extreme conditions, such as famine, the Inuit’s, an Eskimo tribe in Northern Alaska, placed their weak, sick elderly on the ice to die…to save the dwindling resources of the tribe.

We know that the Mayan citizens willingly went to be sacrificed to their gods. Ixtab, a Mayan goddess worshiped in the Yucatan region of Mexico, was followed by those who hanged themselves. To this day, that section of Mexico has the highest rate of suicide by hanging.

We find altruistic suicide throughout history in real life and in literature.

During the second world war, as the troop ship, the Dorchester, was sinking, four chaplains gave up their own life jackets, held hands, singing God’s praise and drowned together. The four included a Roman Catholic priest, a rabbi, a Methodist minister and a Reformed Church in America minister.

In literature, suicide is the solution for love denied in Romeo and Juliet.

Sydney Carton, in Dicken’s novel, A Tale of Two Cities, goes to his death on the guillotine in order to save the life of another. His last thoughts view his sacrificial suicide as “…a far, far better thing I do than I have ever done.”

Schopenhauer wrote of suicide as a question that “man puts to nature, trying to force her to answer.”

Other forms of suicide are sanctioned today.

Some European countries and some states in the U.S. allow “physician-assisted suicide” for those seeking relief from terminal physical illness.

Perhaps, the best book I have ever read on suicide is The Savage God (1970) by Alfred Alvarez, who admits to and describes his own “failed suicide.” Alvarez writes that “…suicide means different things to different people at different times.”

For the longest time in Europe and America, the act of suicide was punished, if it was not completed. Alverez notes that “the savagery of any punishment is proportional to the fear of the act.” And the person who survived his or her suicide was harshly punished. The Catholic church also refused burial in sacred ground for any suicide.

Dante’s 7th circle of hell is “The Wood of the Suicides,” where horrible punishment is meted out for eternity.

For a long time in our society, suicide, much like divorce, was viewed as a failure.

Today, we see suicide as an act of mental illness, a “cry for help” and a result of severe depression. Alverez called suicide due to depression “…a kind of spiritual winter, frozen, sterile, unmoving.”

Some feel that we must guard against turning suicide into a sanitized, emotionally isolated scientific form of epidemiology and record-keeping. There is always this danger when society ‘pathologizes’ a complex human act.

A noted psychoanalyst recently wrote to me about this series on suicide. He noted that it was easy to only think of suicide “as an illness to be cured or prevented.” “Dying, like being born” he wrote, “is an inescapably individual experience. They differ because one cannot choose to be born. Choosing to live in pain or in the face of meaninglessness is an act of will.” He saw choosing not to live as no less an act of will, and “what is important is whether one chooses or is driven.”

We must never forget the suffering that comes before a person attempts suicide. Alvarez notes that at night the depressed person lies down in terror, only to wake up in the morning in despair.

We must continue to hear the voices of those suffering, no matter how faint the cry for help or how disguised the motive…before the final solution of suicide is attempted.

The National Suicide Prevention Lifeline is (1-800-273-8255.)

Complete Article HERE!

Sky Burial; Ancient Tradition of Iran’s Zoroastrians

Ancient Zoroastrians believed the dead body should be put in particular structures to be feasted upon by birds of prey, because the burial or burning of the corpses would cause water and soil to become dirty, which is forbidden in the ancient religion.

The burial traditions in historical periods are known through archaeological evidence and sacred texts like the Zoroastrians’ Avesta as well as Pahlavi texts.

With the recognition of the Zoroastrian religion in Iran, body burial was strictly prohibited and the only way to eliminate the corpses was to place the deceased in rows so their bodies would be feasted upon by birds of prey.

In a Zoroastrian religious text, which is a collection of religious rules and instructions, there are references to the ways to treat with the bodies of the dead. According to these texts, the dead should be put in structures known as dakhma to be feasted upon by birds of prey, because the burial or burning of the corpses would cause the sacred elements of water, soil, and fire to become dirty and it is forbidden to do so.

However, according to the researchers, even in Zoroastrian texts, there are indications that a significant number of people opposed the change in funeral practices, which resulted in penalties. Given that the time passed between the burial and the exhumation, only physical punishments were imposed on the perpetrators, which were practically subject to fines.

According to the findings, for a long time, it was generally thought that burial was more based on putting the corpse outdoor. But extensive scientific studies revealed that the Sassanids, in addition to the tradition of placing the body in the open air, used other burial practices. This can be interpreted in relation to religious communities within the Sassanid Empire and perhaps related to the class division of society in this era.

According to Samer Nazari, a graduate of archaeology at the Isfahan University of Art and his colleague, “the coexistence of religious communities including Christians, Jews, Manicheans, Buddhists and other religious sects in the Sassanid community is one of the main reasons for the diversity of burial practices in this era. At the end of the Shapur I era, the Zoroastrianism was the official religion of the country, but Manichean religion, along with other emerging sects should not be ignored. This comes as Buddhism was also spreading in the East, and Christianity and Judaism were expanding in the western regions.”

Prohibiting Burial of Corpses to Keep Water, Soil Clean

Based on the available information, it is not possible to attribute the burial practices specifically to a particular group, but according to the teachings of the Zoroastrian School, we are aware of the prohibition of burying bodies for the purpose of keeping water and soil clean. Thus, the most dominant burial method during the Sassanid era was to put the deceased body in a dakhma, or towers of silence.

The dakhmas or towers of silence were common until Pahlavi era (20th century). At the time of Pahlavi, the dakhmas were shut down and turned into a burial chamber. But some of the dakhmas are registered as national heritage with domestic and foreign tourists visiting them. The most famous Zoroastrian dakhma is in Yazd province.

Zoroastrian dakhma is known as tower of silence. This dakhma is located 15 km south-east of Yazd near the Safaeiyeh area and on a low-altitude mountain called the mountain of the dakhma.

Although there are Zoroastrian dakhmas in Tehran, Kerman, Sirjan, Isfahan, Taft, Ashkezar, Ardakan, Fars province, etc., the dakhmas of Yazd have more visitors as they are located in the religious capital of Zoroastrianism close to the city and other monuments.

Zoroastrian Dakhma or Tower of Silence

In the past, the site had two dakhmas, which, according to historical documents and Zoroastrian words, both were used for a period of six months. One of these structures is the Maneckji Limji Hataria dakhma, or the Great Maneckji, which is located on the left.

Maneckji, known as Maneckji Sahib, travelled to Iran during the reign of Naser al-Din Shah Qajar, as the representative of “the Association for the Improvement of the Zoroastrian Conditions in Iran,” in order to reduce the pressure on Zoroastrians. Zoroastrians still owe their existence to his efforts.

The second building is Golestan dakhma. During the Qajar period, the difficulty of passing through the mountainous road of the Maneckji caused problems for the burial of the corpses. That is why the Golestan dakhma was built in smaller dimensions. This dakhma could be seen 150 metres west of the Maneckji. The diameter of this dakhma is 25 metres and the height of the wall is 6 metres from the surface of the hill.

The inner surface of the Zoroastrian dakhmas is flat and rounded, all covered with large boulders and consists of three parts: feminine, masculine and childish. Perhaps it’s not bad to know that the end of the circle space, which is attached to the wall around the dakhma, is for the corpses of men, the middle part is for women and the inner circle is for children.

The bodies were placed on these slates according to their gender, and the birds of prey, especially vultures started to eat their flesh. After eating the flesh and becoming completely dry under the sun, the bones were poured into a well in the centre of the circle, called the bone well, to turn into dirt.

All burial practices from leaving the body inside the dakhma until its disappearance lasted about six months to one year. When the dead were placed inside the dakhma, it was customary to mourn, wearing white clothes for three days in ruined buildings next to the dakhmas known as “Khileh”.

Interestingly, in a documentary entitled “The Lovers Wind” made by the famous French director Albert Lamorisse in 1970, part of it was dedicated to the Zoroastrian dakhmas of Yazd. At that time, the dakhma was still open.

Complete Article HERE!

How to have a green burial

‘Current Western funeral practices do prevent a return to the earth’

Duffin-Meadows Cemetery in Pickering, Ont., has a green burial section. There are no individual grave markers. Names are listed on one of four communal monuments by a central pavilion.

By Kevin Yarr

A student of philosophy and biology at Mount Allison University in Sackville, New Brunswick, wants to get people talking about more environmentally-friendly burial options.

Environmentally-friendly burials were the norm for people for tens of thousands of years says Hanna Longard, but in recent decades embalmed bodies, heavy caskets and non-compostable liners in graves have become the norm.

“We come from the land, and so it really to me makes sense that our practices should not inhibit the natural process of decomposition,” said Longard.

“Current Western funeral practices do prevent a return to the earth.”

Opening up a conversation 

Green burials differ in a number of ways from what has become the traditional Western practice.

  • Embalming with compostable fluids.
  • Compostable casket with no lacquers or varnishes.
  • Shallower grave, three to four feet deep, to put the body in range of active root systems.
  • Minimal grave marker.

Longard said cremation is not a particularly green option, because of the emissions involved.

“You take up less space if you’re cremated, is a common idea, because you’re not taking up space on land in a grave,” she said.

“However, you end up taking up space in the atmosphere as excess greenhouse gases.”

Longard has been talking to politicians, people in the funeral industry, and others interested in green burials about options where she goes to school in New Brunswick and around her home town in Mahone Bay, N.S.

Student Hanna Longard is hoping to start a conversation in the Maritimes about green burials.

She has found green burial can be a difficult option to pursue. In Nova Scotia, it is possible to arrange for a burial on private land, but P.E.I. burials have to be in cemeteries. Ontario and British Columbia both have cemeteries that are specifically designed for green burials.

Longard is hoping to start a conversation in the Maritimes about green burials.

Complete Article HERE!

20 physical, behavioural and emotional symptoms of grief and bereavement and how to overcome them

It’s a different road for everyone, but these suggestions could help…


The death of a loved one is one of the hardest things an individual can go through, and there’s no set formula for how their grief will manifest itself.

Bereavement affects everyone differently, and at times it can leave you feeling bereft, alone, hopeless or angry.

The Coping with Bereavement guide from older people’s charity Independent Age reminds us that: “There’s no one way of grieving – everyone deals with bereavement differently. There’s no expected way you should be feeling or set time it will take for you to feel more like yourself again.”

And it’s not just our emotions that are in disarray after the death of a loved one, our bodies feel it, too. Like any other form of emotional stress, the body has a physical reaction which can further add to the sufferer’s distress.

With guidance from the team at Independent Age, here are the physical, emotional and behavioural symptoms of grief. It can be reassuring to know that what you are experiencing is normal, and that the symptoms of grief can be far-ranging. However, if you are worried about anything you are thinking or feeling, including physical symptoms, it’s a good idea to speak to your GP.

Physical symptoms of grief

People are often less aware of these, but grief can affect your body just as much as it can affect your emotions. This is related to the stress of the situation. Everyone is affected differently, but you might experience:

  • Exhaustion.
  • Breathlessness.
  • Aches and pains, such as chest pain and headaches.
  • Shaking and increased heart rate.
  • Feeling sick.
  • Upset stomach.
  • Oversensitivity to noise and light.
  • Skin problems and sensitivity.
  • Lower resistance to illness in general.
  • Panic attacks.

Emotional feelings of grief

Your feelings can be chaotic after a death and this can be overwhelming and sometimes frightening. However, this is usually normal and intense feelings tend to ease over time. Emotional symptoms can include:

  • Anxiety – including worries about your own mortality.
  • Relief – for example if someone died after a long illness.
  • Irritability – although family can be a source of support when you’re grieving, family quarrels are not uncommon after a death.
  • Feelings of detachment – these are particularly common in the period just after the death. You might feel detached from your life, but these feelings usually fade over time.
  • Depression and loneliness.
  • Troubling thoughts.

Behavioural impact of grief

Bereavement can also affect your behaviour. Again, you might expect some of these effects, such as being very tearful, but not others. You might experience:

  • Restlessness or hyperactivity – this can be a coping mechanism.
  • Inability to concentrate – you might be preoccupied with the death and go over and over what happened.
  • Disturbed sleep or nightmares – nightmares and flashbacks can be more common if someone has died through suicide or other traumatic death.
  • Loss of appetite or comfort eating – which can of course also cause physical changes to your weight.


The Independent Age guide explains that it’s really important to be kind to yourself and do things that help you. This doesn’t mean ignoring your grief – allow yourself to feel sad and give yourself time to grieve and remember the person in your own way.

Allow yourself to also grieve for any secondary losses you may experience after a death, for example, having to move out of the family home or no longer having to maintain a role such as mother, wife, career etc.

1. Talk about it

Talking to others about the person who has died, your memories of them, and how you’re feeling can be very helpful. You might want to talk to:

  • Other people who knew the person you have lost
  • A GP
  • Counsellor – more info here
  • Helpline adviser – more info here
  • New research from Independent Age has revealed that almost half (44%) of the sandwich generation (40-64 year olds) do not feel comfortable talking to their parents about death. However, according to the older generation surveyed (over 65s), 58% think it’s important to open up about death. Janet Morrison, Chief Executive of Independent Age says:

    “It’s understandable that many people struggle to talk about death and final wishes. As a nation, we need to start embracing these conversations and promote a positive change in how we perceive and talk about this subject. We don’t expect this to change overnight, but it’s time to take action, be brave and talk about death.”

2. Books that might help

Many people find it consoling to read about other people’s experiences of grief. This can help us to process our grief and feel less alone in our experience. This could be particularly valuable in the early days after a death, when you might not feel ready to talk to others.

You can try:

1. Cruse Bereavement Care – Recommended reading list
2. The Compassionate Friends – Recommended reading list. The Compassionate Friends also operates a postal lending library.
3. Your local library
4. Your GP may also be able to recommend self-help resources.
5. Overcoming Grief, part of the Overcoming self-help series, endorsed by the Royal College of Psychiatrists.

3. Take practical steps

It’s easy to stop caring for yourself when you’re grieving, but a few simple things can help to make this period easier:

  • Try to get plenty of sleep.
  • Eat healthily.
  • Be kind to yourself and don’t put pressure on yourself to feel better too quickly.
  • Avoid numbing the pain too much with things like alcohol, which won’t help you in the long run.
  • Try to keep to a routine – it might feel easier to stop doing things and seeing people, but in the long run this can make you feel worse.
  • Try returning to activities you enjoyed before you were bereaved such as going for a walk, listening to music or swimming.
  • Find small things that help you feel better, like buying yourself flowers.

Complete Article HERE!

Every Estate Plan Should Include These Documents

By Evan Levine, ChFC

Approximately 64% of Americans don’t have a will. Are you one of them? If you pass away without a will, it means you have died “intestate.” When this occurs, the intestacy laws of the state will distribute your property at death. Dying without a will creates many hassles for your loved ones: A probate judge appoints your executor, you have no say in distributing your property, and a judge will decide who will raise your kids if they are minors, to name just a few.

The inflexible nature of intestacy rules will fail to account for special situations or unique circumstances. Serious problems can arise in situations with second marriages, and estates that pass by intestacy rules are more likely to become the subject of litigation.

Estate Documents Every Adult Should Have

Regardless of age, income or occupation, every adult should have the following estate planning documents: 

Will: A will is the heart and soul of your estate plan. It will transfer your assets, appoint a guardian for minor children and name an executorthe individual or institution that takes charge of your estate after you die and distributes your property per your instructions.

Durable Power of Attorney: This document appoints a trusted friend, family member or advisor as an agent to act on your behalf in a variety of financial and legal matters. (For related reading, see: Power of Attorney: When You Need One.)

Health Care Proxy: Sometimes referred to as a health care agent or health care power of attorney, this document authorizes someone to make medical decisions on your behalf. You also may want to consider obtaining a living will (also called an advance directive), which expresses your preferences about certain aspects of end-of-life care. These issues may be covered in the health care proxy or in a separate document.

How to Obtain These Documents

The best way to get these documents drafted is through an estate planning attorney who practices in your state. If you know of one, call them and arrange a meeting. Once they learn about your overall situation and objectives, they may offer recommendations that go beyond the basic documents recommended in this article. Nothing beats personalized advice and planning from a specialist who thoroughly understands your situation and what you want to accomplish. If you don’t know an estate attorney, try to get a referral from a friend, family member or colleague.

If you can’t or don’t want to meet with an estate attorney for whatever reason, you have online options for drafting these documents, which is certainly better than doing nothing. Three of the more popular online resources for drafting estate planning documents are: Quicken Willmaker, Rocket Lawyer and Legal Zoom.

There is a famous expression: “You can prevent what you can foresee.” When you foresee the problems of dying intestate, you can prevent such problems by drafting the estate planning documents covered in this article while you are alive and well. If you’re one of the 64% of Americans without a will, what are you waiting for? The future is uncertain, so get started today!

Complete Article HERE!

How to honor and execute a loved one’s wishes is a conversation worth having

By Judson Haims

While I enjoy almost every day of my job, I am often faced with formidable challenges. One of the most difficult challenges I encounter is discussing plans for end of life with family members, clients and my contemporaries.

During the course of life, most people are required to handle many stressful situations. One of the most stressful and life altering is dealing with the passing of a loved one. Even when families have had the forethought to discuss a shared plan and how to honor and execute the loved one’s wishes, managing emotions, fears and anxieties of family and friends can be tenuous.

When a loved one’s life nears its end, so many areas need to be addressed. Often, it is easy to become overwhelmed and, thus, become immobilized. However, for those who have chosen to accept that the end will eventually come and have taken the time to develop a thoughtful plan, much emotional pain can be spared.

Some of the specific topics that need to be addressed in developing a plan include:

“It is obviously one thing to write about what you should do to initiate these difficult, but necessary, discussions. However, it is quite another issue to face the reality of what to actually say when you are facing a loved one and thinking about how best to break the ice with the topic of death and dying.”

  • Where does the person wish to die, at home, a nursing home, hospital?
  • Who will be a caregiver until the very end? Will it be a family member or friend? Will they have the fortitude to assist properly? Will it be a homecare agency or hospice?
  • What do they want as far as medical intervention, and who is going to make sure the passing person’s wishing are going to be honored and run as smoothly as possible? (Don’t assume a spouse or child will be the best choice.)
  • Establish advanced directives and medical and financial powers of attorney.

For those who have not yet had to experience end-of-life discussions and planning, you will eventually. Don’t shy away from the hard discussions.

It is important to make time and find a place to begin discussions revolving around end-of-life issues. Maybe a group situation might make it easier, such as during a time when families gather together. These conversations can benefit from the “safety in numbers” theory and tend to be more philosophical than one-to-one situations.

Generally speaking, there are four steps to expressing end-of-life wishes:

1. Ask the right question.

2. Record those answers.

3. Discuss among the pertinent people (i.e., family members, loved ones, doctors, attorneys, etc.).

4. File documents. Make certain the important documents are filed on your computer, given to medical providers, family and anyone else who may be involved in advocating.

For those who would like to learn about which documents should be in place when planning for end of life, here are some to consider: advanced directives, living wills, medical durable power of attorney and do not resuscitate orders. Here in Colorado, the Colorado Advance Directives Consortium has made available a document called the Medical Orders for Scope of Treatment, which is designed to help you convey what your wishes are for medical care at the end of your life.

It is obviously one thing to write about what you should do to initiate these difficult, but necessary, discussions. However, it is quite another issue to face the reality of what to actually say when you are facing a loved one and thinking about how best to break the ice with the topic of death and dying.

Should you choose to further educate yourself, there are a number of resources available to assist in starting a conversation: Conversation Starter Kit (the, Aging with Dignity (www.agingwith and Take Charge of your Life (www.takechargeofyour are just a few that you may want to look into.

When end-of-life discussions take place among doctors, family and patients, all the participants tend to feel better. Medical treatment is usually handled with more professionalism and is more effective. And, perhaps the most difficult to measure, the stress of such a difficult situation is drastically reduced.

Complete Article HERE!