End-of-life care: people should have the option of general anaesthesia as they die

By and

Dying patients who are in pain are usually given an analgesic, such as morphine, to ease their final hours and days. And if an analgesic isn’t enough, they can be given a sedative – something to make them more relaxed and less distressed at the end of life. We have recently written about a third approach: using a general anaesthetic to ensure that the dying patient is completely unconscious. This has been described previously, but largely overlooked.

There are two situations when a general anaesthetic might be used in dying patients. The first is when other drugs have not worked and the patient is still distressed or in pain. The second is when a patient has only a short time to live and expresses a clear wish to be unconscious. Some dying patients just want to sleep.

But what type of anaesthesia are we talking about? If you need surgery or a medical procedure, there are three options. First, being fully awake, but having local anaesthesia to block the pain. Second, you could be partly sedated: you would be less stressed or worried about it, but you might remember some of the procedure afterwards. Finally, you could have a general anaesthetic and be out cold, with no memory of the procedure afterwards.

Any of these might be appropriate, depending on the procedure and depending on the person. But the option with the highest chance that you won’t feel anything is, of course, general anaesthesia.

These same three options could be offered to a dying patient. Some people might want to be as awake as possible. (Like the poet Dylan Thomas, they might not wish to “go gentle into that good night”.) Some might want to be sedated, if necessary. Others might want to be completely asleep.

The choice of general anaesthesia at the end of life is potentially popular. Last year, we surveyed more than 500 people in the UK about end-of-life options. Nearly 90% said they would like the option of a general anaesthetic if they were dying.

You might wonder, is this not just euthanasia by another name? Giving someone medicines to ensure that they are unconscious as they die naturally is different from giving someone medicine to end their life. General anaesthesia is legal, whereas in many countries, including the UK, euthanasia is illegal. This means that the option of anaesthesia could be available now for dying patients in the UK without changing the law. France has recently recognised the right for dying patients to be unconscious.

Wouldn’t it be too risky?

There are side-effects with all medicines, but recent advances mean that it is possible to give anaesthetic medicines to patients close to death without affecting their breathing. The medicine is given slowly, and the patient made unconscious gradually over 15 to 20 minutes. The medicine can be slowed or stopped at any point.

Tray of anaesthetic drugs.
Tray of anaesthetic drugs.

Previous studies that have used anaesthesia at the end of life, have continued the medicines for one to 14 days until the patient died naturally.

This will not be for everyone. It may not be possible for those who are dying in their own home. And some people will not want it. But we have the means to offer dying patients a gentle alternative end to their days. We believe that there is a strong ethical case to make the option of general anaesthesia at the end of life more widely available.

Complete Article HERE!

A good death

— Andrea Ucini illustrates how to die well

A new illustrated book, How to Die Well, teaches us how to practically and emotionally prepare for death

By Hannah Silver

Death can be a difficult topic to discuss, and despite its inevitability we can be left feeling surprised or unprepared when confronted with it. A new book, How to Die Well, aims to change this by looking at the four stages of death, from ‘Before you Go’ and ‘Your Funeral’, to ‘Saying Goodbye’ and ‘Good Grief’.

The book, produced by life insurance company Royal London and creative agency Rankin, explores these processes through illustrations by Italian-born, Denmark-based artist, Andrea Ucini. Ucini’s understated style makes a poignant foil for the complexity of the subject matter, with his neat images drawing everyday scenes in simple linework. The muted colour palette and pure form gently subvert the mundane, with the prosaic nature of his portraits lending acceptance to death’s role in life.

Saying Goodbye – Pets and Death

Muslim Final Goodbye

In Saying Goodbye, a couple are divided by a fractured bridge. In Pets and Death, a dog rests behind his owner’s unworn coat and boots which dress an invisible profile. In Before You Go, a couple pause a bike ride to hold each other. Your Funeral depicts a solitary pianist returning to the stage for his final bow, Good Grief a woman embracing emptiness.

The illustrations are a complement to the book which, alongside practical advice from settling estates to writing a will and saying the final goodbyes, offers personal essays; including from photographer Rankin who reflects on his parents’ death. It looks into often stressful issues including palliative care, funeral poverty and assisted dying in a bid to open the conversation around death. §

Good Grief
Before You Go
Saying Goodbye
Before You Go
Before You Go – Writing a Will

Artist Support Pledge one year on: is it here to stay?

There has been one year of #artistsupportpledge, the Instagram initiative that brought income to artists in times of turbulence, and art to collectors at accessible prices. We caught up with founder, artist Matthew Burrows to find out how ASP turned from short term solution to global movement.

One year ago, art galleries had shuttered their doors, revenue streams for artists were evaporating, and the art world began a sustained physical hiatus. Amid this tsunami of uncertainty, a hashtag began taking Instagram by storm.

The Artist Support Pledge (#artistsupportpledge) presented an opportunity for artists to sell their work directly via the social media platform. Though simple, this artist-to-patron, artist-to-artist formula, proved revolutionary. To recap, each time an artist makes £1,000 in sales, they commit 20 per cent of their earnings to purchasing another artist’s work. The rules are not enforced; this is a principle built on trust and generosity, and one year on, the initiative has cast a positive light on the human condition. ‘ASP has proven that the vast majority are only too willing to give generosity a go,’ says Matthew Burrows, Sussex-based artist and founder of Artist Support Pledge. ‘It has fundamentally changed my view on what is possible.’

Portrait of Artist Support Pledge founder, Matthew Burrows. Photography: Jonathan Bassett

Artist Support Pledge, now a non-profit company, was conceived as an open, democratic marketplace based on a sustainable ‘micro-culture and economy’, as opposed to one of aggressive growth. Initially, it was to tide artists over until a three month isolation period lapsed, but as we now know things escalated. ‘Artist Support Pledge was set up as an emergency response to a desperate situation and has evolved into a new cultural economy formed out of a simple idea, who could have imagined that?’ Burrows explains.

‘Sharing economies are at the forefront of economic thinking so it’s prescient that ASP’s impact has caught on. Fundamentally ASP is a movement which operates through cultural values, for the good of the many and not merely the few.’ This is not exactly a new concept; human beings thrived in societies based on similar principles for hundreds of thousands of years pre-industrialisation. As Burrows adds, ‘using digital media to create community-focused economies is the only new part.’

In another major recent development, the initiative has welcomed a-n (The Artists Information Company), the UK’s largest artists’ membership organisation, on board as a supporting partner. ‘It’s a natural match, we are both committed to nurturing and supporting the lives of artists,’ Burrows explains. ‘a-n have been doing it for years and are well set up to support ASP’s ambitions.

It’s also been a year Burrows is unlikely to forget personally; he was made an MBE in The Queen’s birthday honours list, was named Apollo’s Personality of the Year, and was listed among the ArtReview Power 100. ‘I get messages, letters and gifts almost every day from artists, from all over the world, expressing their gratitude. It can be overwhelming’ he says. ‘Some are just happy they have sold a few pieces, others are making a very good living paying rent and feeding their families. Then there are the buyers, who for the first time, feel like they have the opportunity to purchase art, without having to be super-rich.’

One year on, galleries and art spaces around the world are gradually showing signs of emerging from hibernation, but ASP is proving to be far from redundant. ‘There are just too many people living off ASP right now for it to stop.’ says Burrows, who will continue supporting artists in an ever-shifting landscape. He aims to ‘build bridges’ with commercial and public galleries, as well as educational institutions, but for that, he’ll require staff, and ergo funding.

So where will Artist’s Support Pledge be one year from now? Burrows’ goals are characteristically ambitious, but if the initiative’s track record is anything to go by, not unattainable. ‘I hope that ASP will have a team maintaining and developing a vibrant cultural initiative and economy, borne out of crisis into a new order of cooperation and interdependence.’ §

Complete Article HERE!

How to Process the Death of an ‘Ex’

Consider funeral etiquette, emotional impact when a former significant other or spouse dies

by Susan Moeller

When a former spouse dies, divorce is no protection against grief. That’s what Linda Gravenson discovered when her ex-husband died in 2019. Although they had not lived together for 30 years, she found herself grieving his passing and the ultimate finality of their relationship. Yet as the former wife, she had no official standing in the process that followed his death, either emotionally or as a participant, except as their grown son’s mother.

“I wasn’t truly the widow,” says Gravenson, a freelance conceptual editor and author who, last winter, wrote an essay about her grief for The New York Times. “There was no place to go with that except internally back into my own memory.”

Gravenson’s experience hit a nerve. The essay, which described how her husband’s death sucked her down a hole of memories related to their relationship and the divorce, drew about 450 comments, either online or on Facebook. As she observed, there’s no cultural place for her category of grief. She didn’t feel comfortable, for example, joining a support group for widows.

“Did I qualify for support after 30 years of living apart?” she muses. “Can grief for loss be rekindled by final loss? I think that’s the real point of the piece.”

Acknowledge the grief

The death of a former spouse or long-term partner is a form of “disenfranchised grief,” meaning that society does not necessarily sanction it as legitimate, according to bereavement expert Kenneth J. Doka, who coined the phrase. In other words, since you are divorced, you should be immune from the grief of the loss. But experts say that the passing of an ex-spouse or partner can be intense. Gravenson, for one, had to finally let go of any hope that her husband would tell her that the 20-plus years they spent together “wasn’t nothing.” And, as Gravenson says, his death triggered grief over earlier losses.

“Bereavement really means it’s the permanent separation between you and the person that you loved or that you had an attachment [to],” says Michael Cruse, a licensed clinical social worker and the bereavement services manager at Hospice of Santa Barbara, a California nonprofit.  “But in that depth, it connects that bereaved person to all the other losses in their life. And usually there’s a loss in that marriage as well, because nobody plans to get divorced when they get married.”

These days, many of those splitting or getting divorced have been together a long time or share children. While the overall divorce rate is declining, the rate among those 50 and older has doubled since the 1950s, according to the Pew Research Center.

“In the modern world, ex-spouses don’t have to be enemies of one another,” Cruse notes. “They can actually be very civil and supportive in relationships. And so there’s still a lot of attachment.”

Assessing legal, funeral concerns

There’s no rulebook for attending a former spouse’s or partner’s funeral or for learning how to grieve the loss.

“Depending on how long ago it’s been since the person died, whether there’s kids or not kids, [there are] those practical questions of ‘Should I be involved in the funeral?’”  says Litsa Williams, a clinical social worker and cofounder of WhatsYourGrief.com, an online grief counseling service based in Baltimore.

If you find yourself in Gravenson’s situation — perhaps surprised by the grief you feel for a former spouse or partner and not sure about the emotions or the etiquette — here are some suggestions on how to move forward.

• Know where you stand legally. “If the ex-spouse is still the beneficiary on the insurance that can cause a lot of problems,” says Ellen McBrayer, president of Jones-Wynn Funeral Homes & Crematory, near Atlanta. Also, consider your own advance care directives, Williams advises. Clear instructions on end-of-life care or funeral arrangements will make it easier on adult children and other family members who may face decisions complicated by divorce or acrimony. “The more that someone can put their wishes in writing in advance, the easier it tends to be and the less conflict we tend to see,” Williams says.

• Communicate openly and respectfully. Williams and others suggest having a conversation with extended family or the most diplomatic family member so you can explain what’s important to you about being at a service and ask how others feel. It’s even better if you can talk before death occurs. Then, she says, be open to negotiation. For example, maybe your ex-spouse’s wife would be comfortable with you at the funeral but not coming back to the house afterward.

Try to reach a place where “everybody can feel like they’re having their need for that ritual met … while being respectful of each other,” Williams says.

Talk with the funeral director. McBrayer stresses that funeral homes want to create safe spaces for families to grieve, even if that means holding two services or figuring out another way to commemorate the death. While they can’t mediate family conflict, funeral directors and pastors can help brainstorm a solution or provide a neutral location to talk.

“Family dynamics in general can be complicated with blended families,” McBrayer points out. “So we just really try to work with a family.”

• Get support. You may think that you are the only one who doesn’t fit into the traditional architecture of bereavement, such as widow support groups, but others have the same issue. “We hear this all the time,” Williams says. “I’m too young to go to a widows group. My husband died of an overdose; their husbands died of cancer. I’m in an LGBT relationship … everyone else there is straight.”

If you decide to join a bereavement support group, she suggests being upfront about your anxiety, to see if it’s the right place. Cruse recommends starting with individual therapy. He says the Santa Barbara hospice organization works with clients individually first and then suggests a support group if appropriate. You can also find help online, through bereavement counseling practices like What’ s Your Grief or through peer-supported grief forums, such as that run by Marty Tousley, a former bereavement counselor.

Complete Article HERE!

Epictetus on Love and Loss

— The Stoic Strategy for Surviving Heartbreak


“Who is good if he knows not who he is? and who knows what he is, if he forgets that things which have been made are perishable, and that it is not possible for one human being to be with another always?”

By Maria Popova

“Future love does not exist,” Tolstoy wrote in contemplating the paradoxical demands of love. “Love is a present activity only. The man who does not manifest love in the present has not love.” It is a difficult concept to accept — we have been socialized to believe in and grasp after the happily-ever-after future of every meaningful relationship. But what happens when love, whatever its category and classification, dissolves under the interminable forces of time and change, be it by death or by some other, more deliberate demise? In the midst of what feels like an unsurvivable loss, how do we moor ourselves to the fact that even the most beautiful, most singularly gratifying things in life are merely on loan from the universe, granted us for the time being?


Two millennia ago, the great Stoic philosopher Epictetus (c. 55–135 AD) argued that the antidote to this gutting grief is found not in hedging ourselves against prospective loss through artificial self-protections but, when loss does come, in orienting ourselves to it and to what preceded it differently — in training ourselves not only to accept but to embrace the temporality of all things, even those we most cherish and most wish would stretch into eternity, so that when love does vanish, we are left with the irrevocable gladness that it had entered our lives at all and animated them for the time that it did.

In The Discourses of Epictetus (public library), under the heading That we ought not to be moved by a desire of those things which are not in our power, the Stoic sage writes:

Who is good if he knows not who he is? and who knows what he is, if he forgets that things which have been made are perishable, and that it is not possible for one human being to be with another always?

Epictetus — a proponent of the wonderful practice of self-scrutiny applied with kindness — proceeds to offer a meditation on loosening the grip of grief in parting permanently from someone we have loved:

When you are delighted with anything, be delighted as with a thing which is not one of those which cannot be taken away, but as something of such a kind, as an earthen pot is, or a glass cup, that, when it has been broken, you may remember what it was and may not be troubled… What you love is nothing of your own: it has been given to you for the present, not that it should not be taken from you, nor has it been given to you for all time, but as a fig is given to you or a bunch of grapes at the appointed season of the year. But if you wish for these things in winter, you are a fool. So if you wish for your son or friend when it is not allowed to you, you must know that you are wishing for a fig in winter.

“How Long Is Now”

In a sentiment addressing the corporeal mortality of our loved ones, but equally applicable to the loss of love in a non-physical sense, Epictetus adds:

At the times when you are delighted with a thing, place before yourself the contrary appearances. What harm is it while you are kissing your child to say with a lisping voice, “To-morrow you will die”; and to a friend also, “To-morrow you will go away or I shall, and never shall we see one another again”?

When we are able to regard what we love in such a way, Epictetus argues, its inevitable loss would leave in us not paralyzing devastation but what Abraham Lincoln would later term “a sad sweet feeling in your heart.” To retain the memory of love’s sweetness without letting the pain of parting and loss embitter it is perhaps the greatest challenge for the bereaved heart, and its greatest achievement.

Complement this particular fragment of Epictetus’s abidingly insightful Discourses with computing pioneer Alan Turing on love and loss and other great artists, scientists, and writers on how to live with loss, then revisit more of the Stoics’ timeless succor for the traumas of living: Seneca on resilience in the face of loss, the antidote to anxiety, and what it means to be a generous human being, Marcus Aurelius on living through difficult times and how to motivate yourself to rise each morning and do your work.

Complete Article HERE!

Can Losing a Loved One Make You More Grateful?

Research suggests that loss can remind us of the preciousness of life—a lesson that one researcher learned firsthand.

My sister and I sat in my mother’s bedroom—her sanctuary and prison, where cancer had kept her confined on and off for the past six years—as she looked out the window longingly. The stunningly sunny July day reminded her of everything she loved doing outdoors: tending to her roses, smelling strangers’ babies’ heads, cheering for her children on the cross-country course.

She was getting cranky. Hindered by dry lips but motivated by restless legs, she pleaded in her best Jewish grandmother voice. “You guys have gotta get me out of here,” she said, smiling coyly. “I’m dyin’ in here…”

Morbid, mom.

My sister and I exchanged a skeptical glance as we looked at the tubes and machinery she was connected to, the bag of nutrients that was keeping her alive, and considered the implausibility of any excursion. Though mom clocked in at 5’2” and under 100 pounds, we knew a battle was fruitless; when she set her mind to an idea, we had no chance of stopping her.

A self-identified flower child who read Pema Chodron and Thich Nhat Hanh, my mother fought two forms of cancer over 16 years before her death. The disease took her hair, breasts, ovaries, fallopian tubes, and uterus, along with a third of her intestines. But her humanity grew. Following her first diagnosis when I was three, she and her closest friends championed a non-profit called Healing Odyssey, a women’s retreat for cancer survivors.

As odd as it may seem, I am a more grateful person today as a result of losing my mother. As I watched her fight with her everything to stay on this planet—to spend another day with my father, the love of her life, and to support my sister and me through our trials and triumphs—I began to value my life more.

Of course, I had moments when I raged at the top of my lungs at cancer, and I’ll never forget when the man from the morgue wheeled her body out of our house for the last time. But my appreciation for life also grew undeniably—and it led me to conduct research that would eventually explore how the death of a parent can inspire gratitude.

Grateful after loss

Nine years following my mother’s death, I was studying loss, childhood trauma, and resilience for my doctorate (they call research “me-search,” after all). I began wondering whether the experience of gratitude growing through loss might be universal. Early on, I came across a study that showed that our sense of gratitude can increase when we reflect in a personal way on our own death.

The authors of this study attributed the phenomenon to the “scarcity heuristic,” whereby we value things more when they are rare or scarce. So when we’re faced with death, the value we place on life rises. This was my experience. In witnessing my mom die at 53, suddenly life felt very short, and each moment became incredibly important.

I was excited to see my experience mirrored back to me in research, and inspired to study whether losing a parent in childhood made people more grateful. As a starting point, Katie McGovern and I asked 350 adults who had lost a parent about their gratitude, depression, psychological well-being, and post-traumatic growth (positive change experienced following a major personal crisis or traumatic experience), as well as how their gratitude changed as a result of the loss.

Unsurprisingly, we found that those who rated themselves higher in gratitude reported lower levels of depression, and greater levels of psychological well-being and post-traumatic growth. In other words, the more grateful participants were faring better than those who were less grateful.

Even more interesting, though, was that 79 percent of respondents believed that their experience of gratitude increased as a result of losing their parent, as opposed to roughly 13 percent who reported no change in gratitude and only 8 percent who reported that their sense of gratitude decreased.

Because this study was correlational, questions still remain regarding whether adults actually developed gratitude because of the loss or were already grateful people beforehand. Also, it may have been difficult for people to accurately remember their gratitude levels prior to the loss. As such, we could only speak to their perceptions of changes in gratitude. Stronger evidence would come from a long-term study that observes how gratitude changes in children before and after losing a parent, compared to children who don’t lose a parent.

“Losing my mother reminds me daily how precious life is and that I shouldn’t take a single second for granted”

Still, a large majority of the adults in the study felt as I did—that losing their parent made them a more grateful person. In order to understand this in a more nuanced way, we invited people to write about their experience and analyzed the responses. The most common themes that people reported were related to realizations that life is precious, feelings of gratitude for family and friends, and a recognition of impermanence.

I was particularly moved by a quote from one woman in the study. “Losing my mother reminds me daily how precious life is and that I shouldn’t take a single second for granted,” she said. “From darkness I eventually came into the light.”

When gratitude is hard

My mother was a wonderful, thoughtful person who tried as hard as she could to make hers a “good death.” She joked about mortality and signed notes to us with “I love you eternally,” part of a broad campaign to prepare my family for her death. She wrote letters to my sister and me to be opened on our wedding days, and she recorded herself on a Walkman reading our favorite childhood stories so she could read to her grandbabies. As painful as it was to see my mother suffer over multiple years, we were given the gift of time. We held each other and laughed and cried together as much as we possibly could have in that period between diagnosis and death.

When I entered into my research about loss and gratitude, I wanted to acknowledge that not everyone who had lost a parent had experienced a “good death” as we had. They may not have had a parent who was so conscientious about preparing them for their death, a close relationship with the parent, or the opportunity to say goodbye. I didn’t want the research to paint an unrealistically rosy picture or minimize the incredible pain that comes with loss. And the last thing I wanted was for those who were grieving to feel like they should be feeling grateful.

As a result, we also studied why it was challenging for some of the participants to access gratitude following the loss of a parent. We found, unsurprisingly, that those who experienced additional traumatic events in adulthood were struggling more. When people believed their gratitude decreased following the loss, they tended to attribute it to fear, anxiety, and a feeling that they couldn’t depend on others.

I most certainly do not feel grateful every day. I become angry every Mother’s Day, and embarrassed about the envy I feel toward the beautiful connection my best friend has with her one-year-old son. In every accomplishment or milestone I achieve, there is a tinge of melancholy—it serves as a reminder that the world has continued spinning without my mom in it.

In living with this incredible burden and gift of parental loss, no feelings are simple or singular. In the overwhelming wave of sadness I feel envelop my heart when I smell her perfume on a stranger or wake up from a dream in which she visits me, there is also a deep achy joy in feeling connected to her. This is the gift of grief: an opening to the complexity of moment-to-moment experience, which, for me, inevitably gives way to gratitude.

What truly matters

On that July day, we carefully guided mom into the passenger seat of her yellow Volkswagen Beatle and drove to an overlook in Laguna Beach. Left arm clasped to mine and right arm clasped to my sister’s, my mother shuffled down the pathway leading to the water. With a halt, she pointed out a crop of angel-wing jasmine. “You guys have to smell these,” she coaxed, with that same look she would have in front of a piece of chocolate cake—eyes wide, guilty of an indulgence. I watched her as she closed her eyes, dipping her face into the small, star-shaped flowers and drinking in their scent as if they were a life force.

We continued down the path toward the edge of a cliff—a meeting place between two worlds—and pressed against the railing. The three of us stood, hand in hand, and our eyes softly closed as the sun warmed our skin. For the first time in the six years since she was diagnosed with ovarian cancer, our shoulders released. We breathed fully and calm swept over us.

“This is where spirituality lies,” my mother said, with the surety of a new discovery. Staring death in the face and marveling at the supreme beauty of the universe, something in her had shifted. Her mama-bear stubbornness, her moments of confusion, anger, and sadness, were replaced by a calm acceptance. And my sister and I followed her lead.

Mom took us to the edge that day with her, to confront our own deaths as well as hers. In moments like this, what truly matters quickly shifts into focus; it becomes glaringly obvious that our time here is so finite and death can come at any moment. As the sea salt mist caressed our faces, we held each other tightly, in preparation for letting go.

Complete Article HERE!

Coping with a pet’s accidental death

— especially when you blame yourself

The author is mourning the loss of Suzy, an Australian cattle dog puppy.

By Gavin Jenkins

I parked my car in my girlfriend’s driveway. We were returning from the park that Sunday in November, and Bob, my 3-year-old border collie mix, bounced around the back seat, trying to avoid Suzy, our rambunctious 5-month-old Australian cattle dog, who had a habit of biting his neck and legs.

My girlfriend exited the car first and, as I got out, she opened a back door. Bob jumped out and raced toward the backyard. Suzy, a blue heeler who had big, pointed ears, a stumped tail and a white face, normally followed Bob. If she didn’t chase him, she was easy to grab, thanks to a seven-foot-long leash.

But we didn’t have the leash that morning. Earlier, when we were in the kitchen getting ready to leave, my girlfriend said the leash was on the third floor. Sensing an imminent departure, the dogs sprinted around us, barking and crashing into furniture. Frustrated, I picked up Suzy and said, “I’ll just carry her. Let’s go.”

I remembered to keep Suzy in my arms getting in and out of the car at the off-leash park, but when we returned to my girlfriend’s house in Pittsburgh’s East End, it had slipped my mind. Without a leash, Suzy zipped past us. But instead of following Bob, she ran into the street.

What happened next — the blur of a black SUV and Suzy’s cry as she died — is seared into our memories.

Grieving the loss of a pet is often as painful as mourning a close friend or relative. But being responsible for and witnessing your pet’s death can add guilt, trauma and shame to the heartbreak. And as we discovered after Suzy died, this emotional toll impedes the grieving process.

The pet industry has begun to help people mourn. Veterinary social work is a growing profession, and pet bereavement groups have become common. Cheri Barton Ross, an adjunct psychology professor at Santa Rosa Junior College, is a pioneer in the field. After a few one-on-one sessions with pet owners through her husband’s veterinary office in California, she started hosting pet loss support groups in 1986 because she realized groups work better because they allow people to see they aren’t alone.

“People often felt embarrassed and isolated in their grief for a pet,” she said. “However deep those bonds go for whatever it is that you loved, that’s how deeply you’re often going to grieve.” She also said people can develop post-traumatic stress disorder from witnessing their pet accidentally die. “With couples or families, you either pull apart or pull together in this crisis,” said Ross, co-author of “Pet Loss and Human Emotion.” “You might blame each other or blame yourself and not be able to navigate different stages of grief.”

My girlfriend and I each blamed ourselves for the death of our first shared pet. We had gotten Suzy because we had time, while working from home during the pandemic, to raise a puppy together. Talking through what happened helped ease the grief and brought us closer. However, she initiated the conversations, and I only participated reluctantly. After eight years of therapy, I know articulating emotions is important, but part of me falsely believed that not talking about the accident would take my mind off the image of Suzy’s lifeless body and make the pain go away faster.

My upbringing enhanced my reluctance. When I was a boy in suburban Pittsburgh, my dad competed in dogsled races, and our family had a kennel of huskies along the driveway of our six-car garage. A few of our pets died tragically, most notably our wolf, but we never talked about it. The family motto was, “It’s over; move on.” So, whenever my girlfriend brought up Suzy, I had to check my impulse to regurgitate my dad’s response. And then I’d tell the truth: “I replay her getting run over in my head every day.”

Walking past the accident site often triggered a flashback. Ross said this is so common that she’s had clients who moved to escape the bad memories. People also avoid certain roads. Kevin Nicholson, a 41-year-old cybersecurity information engineer I met in a pet loss group page on Facebook, told me over the phone that he hasn’t turned left out of his Long Island street since early March, because that’s where Lulu, his family’s 1-year-old cavapoo, slid out of her harness during a walk, ran into traffic and died.

Paweenudh Suanpan stopped driving on a section of Route 108 in Maryland after a teenage driver crashed into her car there in 2017. Piper, Suanpan’s chocolate Labrador retriever who was in the back seat, was thrown so forcefully that she was paralyzed and had to be euthanized. “I need to return there and close the loop,” said Suanpan, 34, “but I just haven’t yet.”

Suanpan, a special-education teacher who has become an advocate for dog safety belts, said she still blames herself for not securing Piper, just as my girlfriend still beats herself up for opening the car door and I can’t forgive myself for not running upstairs to get that leash.

“Every single person blames themselves,” said Dani McVety, a veterinarian who co-founded Lap of Love Veterinary Hospice, an in-home end-of-life care provider that also hosts pet loss support meetings online. “Whether you had an accident or come home to find that your 15-year-old dog passed away naturally, there’s always guilt.” Owners might blame themselves for not realizing sooner that their pet was sick, she added, or for knowing they were sick but waiting too long to euthanize.

Deciding when to euthanize is fraught. Kristeen McPherson, an accountant I also met through a pet loss group page on Facebook, and her husband euthanized Carly, their 12-year-old golden retriever, after surgery and chemotherapy couldn’t keep the dog’s cancer at bay. McPherson, a 60-year-old Harrisburg, Pa., resident, said she feels guilty despite the medical interventions, because, “If it were me, I hope they wouldn’t put me down and just keep trying and trying.”

McPherson said their dog was more of a family member than a pet. Describing a pet like this has become the norm, and it’s a fundamental shift from how they were treated a generation ago. The pet industry, which rakes in more than $100 billion each year, has dubbed it the humanization of pets.

Debbie Stoewen, a veterinarian who became a social worker in 2005 to help pet owners grieve, said the evolution of the human-animal bond can also be seen in how many pets today sleep in their owner’s beds and are referred to as furbabies. “The emotionality of pet owners, who we now call pet parents, is so deep and complex,” said Stoewen, who lives in Ontario, Canada. “This heightened bond amplifies the grief.”

Suzy playing with her companion, Bob, a border collie mix. She liked to herd and nip at him.

My girlfriend and I grieved differently. She told her close friends and family privately, and the more she talked, the better she felt. My shame ran so deep that I wanted to get another Australian cattle dog with a stumped tail, name her Suzy and never tell anyone. As a childless 40-year-old, part of my identity was tied to being a dog owner, and I was terrified people would think I wasn’t a good one.

After talking to my therapist, I finally opened up to people. But the shame didn’t recede until I joined a private Facebook group dedicated to grieving for dead dogs and realized how many other people had lost pets to car accidents.

Lindsey A. Wolko, founder of the Center for Pet Safety, wrote in an email that there are no official statistics tracking how many dogs are killed by cars each year. But it happens so frequently that emergency veterinarians have a term for it — HBC (hit by car). McVety, who worked in an emergency veterinarian hospital in Florida at the start of her career in the mid-2000s, said that she sometimes saw five HBCs a night. The term also applies to cats; McVety said that they, like dogs, are often accidentally run over by their owners in the driveway.

Stoewen, the veterinarian/social worker who is the director of veterinary services for Pet Plus Us, a pet health insurance company in Canada, said she can relate to what I’ve gone through. One morning 20 years ago, one of her dogs escaped her yard and was run over. The experience helped her become a better veterinarian and dog owner, she said. “The way you lost that pet is part of you, like an imprint. With your next dog, you’re going to be that much more careful and intentional.”

There is no right or wrong time to adopt a new dog, according to Ross, the psychology professor. She said her only advice is to make sure the new dog is not a replacement for the one that died: “No matter what, you’re going to grieve that loss.”

My girlfriend and I learned this lesson, too. A few days after Suzy died, we got another Australian cattle dog because a breeder had an available puppy, and we wanted an immediate shot at redemption. It wasn’t easy. Until we worked through our trauma, playing with the new puppy, who we named Isabelle, made us feel even guiltier about Suzy, and we experienced anxiety while walking her on a busy street or getting her out of the car.

Bob, my border collie mix, probably wishes we had waited longer. Like Suzy, Isabelle is a natural herder and constant nipper.

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Ideal Practices For Providing End-Of-Life Care To A Loved One


In a wheelchair in a nursing home, a woman in the last stages of a metastatic malignant breast tumor was asked what she needed for her 75th birthday. “Life” was her answer.

Aging and developing chronic medical health problems is a natural process. Unfortunately, some individuals have it harder than others and develop terminal illnesses that take a drastic toll on their health and those looking after them. In such situations, the best that close friends and family members can do is make the patient’s remaining time as pleasant and manageable as possible. The appropriate solution to turn to is good hospice or end-of-life care.

You may have heard the terms ‘palliative care.’ Suppose you have a friend or relative who has a terminal illness or is dying. In that case, palliative care aims to relieve suffering and handle problems while treating an actual illness such as cancer. The primary objective of end-of-life care is to ensure patients experience an acceptable level of comfort, personal satisfaction, and medical assistance.

Palliative care can help people who are no longer receiving treatment or whose illness is nearing death. It helps identify end-of-life care needs and facilitates trained caregivers and family members to meet all patients’ needs. It can take place at home, in nursing homes, and hospice care facilities. The palliative care team can help you set treatment goals and make crucial decisions.

Your loved one may lose the ability to speak, sit, walk, and eat. Daily tasks such as washing, grooming, dressing, and turning require full assistance from a caregiver. Your companion, the hospice team, or a caregiver with a terminal degree in nursing recommended by your doctor, can help you with these tasks. To ease the suffering, consider these ideal practices while providing end-of-life care to a loved one.

Talk to them and listen to what they have to say

Patients who know that their life is coming to an end may contemplate their beliefs, self-worth, or the purpose of their life. They may have questions about how they will be remembered or think of apologies or forgiveness from others. If the patient needs to talk about perplexing issues, you can speak and ask open or closed questions. If you’re not much of a talker, just lend an ear and listen as they unburden. Alternatively, you can also read books together, play music, or bring up very personal qualities of the patient.

Provide emotional support

Battling terminal illness and end-of-life situations can be emotionally exhausting for the experiencing them. If you are there, you can offer emotional support. Your presence nearby, sitting quietly, or holding hands can be comforting and reassuring. You can also make arrangements for other loved ones to visit and extend their support. However, to keep the patient’s comfort in consideration and ensure that you plan visits accordingly. That way, you’ll avoid too many people showing up at one time.

Creating a quiet environment with soft lighting and gentle music to remove distractions can improve the person’s mood, stimulate memories and help a person relax.

Provide comfort

Most terminal patients do not wish to make their caregivers uncomfortable. However, the truth is that there is only so much that you can do to provide comfort to someone in their final days. Given the situation, every bit counts. Consider the following tips:

  • While feeding, give a small spoonful of food. Cook meals enriched with essential oils and nutrients to ensure they’re eating healthy. It would be best to consult a doctor before meal prep to avoid giving them something that’s off the plate.
  • Dab the face with a slightly damp town to reduce dryness around the eyes. Apply medical-grade cosmetics to keep the appearance fresh and lively.
  • To facilitate breathing, gently turn the patient’s head, change the pillow or raise the head of the bed. Use a humidifier with a cool mist.
  • Apply ointments carefully on dry skin to reduce irritation.
  • Learn how to move and reposition people in bed to avoid injury.
  • Learn how to change sanitary pads, adult diapers, or insert a catheter to avoid discomfort while removing body waste.
  • Speak gently and reassuringly. Hold the patient’s hand or touch her/him gently and frequently ask if they need anything.
  • Use painkillers recommended by a doctor/professional caregiver only.
  • Observe whether the person is hot or cold. Change room temperature and bedding if necessary.

Consider respite care

It’s no easy feat to look after a patient in an end-of-life state; it takes a lot of patience, understanding, and nerve. The patient probably has many medical dispositions that require professional attention. You must be tolerant and composed enough to deal with that. However, there are alternatives to conventional caregiving options that can prove to be quite beneficial.

 Respite care aspires to provide relief for you and your family from the difficulties associated with end-of-life care. Respite care offers a unique opportunity for a mental break and recreation for everyone involved in the process. Not only is this method effective in providing comfort, but it serves as an excellent break from the otherwise gloomy atmosphere in traditional caregiving facilities. A hospice volunteer may spend a few hours meeting the patient to check on their health, or the patient may visit the hospice office close-by to the retreat.


Providing terminal care to a loved one can be emotionally and physically exhausting. The ideal way to go about it is by providing emotional support and comfort to your loved one. Support them, talk to them, and help them out with routine tasks such as eating and cleaning. Consider on-boarding a trained professional to ensure that you do not falter along the way.

Additionally, it would be wise to keep a watch on your own physical and mental health. You will be unable to look after your loved one if you cannot cope with the fatigue and stress that accompanies taking care of someone in their final moments. Don’t forget to love yourself in the process.

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