She’s 51, a mother and a devout Catholic. She plans to die by euthanasia on Sunday.

Martha Sepúlveda is pictured with her son, Federico Redondo Sepúlveda. The mother, now 51, plans to end her life by euthanasia on Sunday.

By Samantha Schmidt and Diana Durán

It began with a strange feeling in her hand, a weakness in the thumb that made it difficult to hold a pen or grip a computer mouse.

In November 2018, a doctor gave Martha Sepúlveda her diagnosis: amyotrophic lateral sclerosis, the progressive neurological disease known in the United States as Lou Gehrig’s disease. In the months that followed, the Colombian woman lost control of the muscles in her legs — and she knew it would only get worse.

She would cry at night, overwhelmed by the thought. “What happens once I can no longer get into bed or use the bathroom without help?” she would ask her son. “How far am I going to go?”

Sepúlveda started reading about an option that could relieve her fear of what was to come: Euthanasia. Colombia, she learned, is the only country in Latin America — and one of only a few worldwide — that permits patients to end their lives.

Until this year, the option has been available legally only to those who are expected to live for six months or less. On Sunday, Sepúlveda, who considers herself a devout Catholic, plans to become the first person in Colombia without a terminal prognosis to die by legally authorized euthanasia.

Colombia’s constitutional court ruled in July that the right to euthanasia — recognized here in 1997 — applies not only to terminal patients, but also to those with “intense physical or mental suffering from bodily injury or serious and incurable disease.”

The ruling has divided the faithful in this majority-Catholic country. Church officials have described euthanasia as a “serious offense” to the dignity of human life; a member of the national bishops’ conference urged Sepúlveda to “calmly reflect” on her decision and invited all Catholics to pray that God will grant her mercy.

But Sepúlveda, 51, has been resolute in her response to those who question her plan — or her faith.

“I know that God is the owner of life,” she told Colombia’s Caracol News. “But God doesn’t want to see me suffer.”

This South American nation is an unlikely pioneer in euthanasia. An estimated 73 percent of the population is Catholic. Eleven Catholic feast days are national holidays. Access to abortion is sharply limited.

And yet Colombia was one of the first countries in the world to decriminalize euthanasia, and one of only a small number — alongside Belgium and the Netherlands — to extend the right to non-terminal patients. No U.S. state permits euthanasia; 10 states and the District of Columbia allow medically assisted suicide for terminally ill, mentally capable adults with a prognosis of six months or less to live.

Now, advocates here are hoping their movement will spread across Latin America, according to Camila Jaramillo, a lawyer representing Sepúlveda with the Laboratory of Economic, Social and Cultural Rights (DescLAB). Campaigns are underway in Uruguay and Chile. In Peru this year, Lima’s superior court ruled that a woman with polymyositis should be permitted to die by euthanasia when she decides she is ready.

How did a country of Catholics, often led by center-right politicians, become a leader in euthanasia rights?

Eduardo Díaz Amado, director of the Bioethics Institute at Pontifical Xavierian University in Bogotá, traces the development to the country’s long civil war and the violence wrought by drug lord Pablo Escobar. In 1991, in response to the country’s instability, Colombia rewrote its constitution. Unlike its “paternalistic” predecessor, Díaz said, the new constitution expanded individual rights, emphasized “the respect of human dignity” and underscored the separation of church and state.

The document also established a constitutional court to help define these newly recognized rights. Within six years, the new court, now with several progressive judges, took up a case from a plaintiff who argued that “mercy killings” should carry the same penalty as any other homicide.

The court disagreed. Instead of increasing the penalty, it moved to decriminalize euthanasia — becoming the only country to do so on the basis of constitutional arguments, Díaz said.

But it took more than 15 years for authorities to apply the ruling. As political leaders sought to avoid the subject, doctors such as Gustavo Quintana met growing demand for the practice. Known as the “doctor of death,” Quintana is said to have provided euthanasia to close to 400 patients before his recent death.

In 2014, the court ordered the government to issue guidelines so that hospitals, insurers and health professionals would know how to proceed with euthanasia requests.

The movement for euthanasia rights has drawn unexpected allies: Catholic priests. Alberto Múnera, a theology professor and Jesuit priest at the Pontifical Xavierian University in Bogotá, lectures his students on the “exceptions” to the “absolute value of human life” in church teaching. When Catholics follow their own consciences, even when that means choosing to end their own lives, he argues, they will “behave well” in the eyes of God.

Since the government began regulating the practice in 2015, 157 people have died by euthanasia in Colombia, according to official data. One hundred and forty-one had some type of cancer. But many others, including Sepúlveda initially, were denied requests because their illnesses were not deemed terminal in the short term. Last year, a team of lawyers filed a lawsuit asking the constitutional court to extend the right to patients with non-terminal diagnoses.

The court went further, recognizing a right to euthanasia for those with “intense physical and mental suffering.” That was a surprise even for the lawyers, who did not mention mental illness in their complaint. And it drew immediate rebuke from church leaders and conservative politicians.

“It opens up the possibility for people who are depressed or simply don’t want to live anymore,” said Sen. María del Rosario Guerra, a member of the Democratic Center party of President Iván Duque. “We are promoting a culture of death

Bishop Francisco Ceballos, a leader within the national bishops’ conference, has criticized news outlets here for depicting Sepúlveda “heading toward death with so much joy.” He has emphasized the church’s support for palliative care as an alternative to euthanasia. “We believe that death cannot be the solution to suffering and pain,” he said.

The court’s ruling in July came less than a month after the death of Yolanda Chaparro, a 71-year-old Colombian woman with ALS who had requested euthanasia a year earlier but was rejected because her prognosis was not deemed terminal. She continued to deteriorate until she could no longer breathe without oxygen, struggled to move on her own, and lived with a fear that she could drown in her own saliva, according to her daughter. She was granted her wish to end her life in June.

Shortly before her death, Chaparro sat down with her relatives to explain her decision. “For me, to live is to fly,” she said, in an interview recorded by relatives. “To live is to walk, to create. To live is to commit to dreams you’ve formed your whole life. So seeing that each day everything is more difficult … all of that is over.”

When Federico Redondo Sepúlveda learned of the court ruling, he broke down in tears. The 22-year-old law student, Martha’s only child, had spent months helping his mother file a request for euthanasia.

“I didn’t think it would happen so soon,” he said. He had tried to find the strength to support his mother in what for him has been an excruciating choice.

“She kept saying the same thing, that if I loved her then I would support her,” he said.

They have spent his mother’s final days mostly watching Netflix — a joy she discovered during the coronavirus pandemic. They’ve watched and re-watched “The Pianist,” “Forrest Gump,” and “The Shawshank Redemption,” movies that remind them of years past.

The family doesn’t have special plans for his mother’s final night Saturday. She hopes to spend it as she always does, by going to bed early. She plans to end her life at 7 a.m. on Sunday, when she would normally be heading to church. Her son will be the only person in the room with her, he said.

Her body is to be cremated immediately. Federico plans to spread her ashes in the Caribbean Sea, off Colombia’s northern coast. But first, he will join with their family, her remains beside him, and take the Eucharist

Complete Article HERE!

Death and psychedelics

— How science is reviving this ancient connection

By

In November 1963, the writer and psychedelic explorer Aldous Huxley laid in bed, unable to speak. He was dying of cancer. One of his final acts was to pass a handwritten note to his wife Laura. 

His famous last words: “LSD, 100 µg, intramuscular.”

It was Huxley’s dying wish: a large dose of acid, please. Laura Huxley fulfilled the request twice during her husband’s final hours.

First synthesized 25 years before Huxley’s death, LSD was still legal in 1963. Scientists were studying it as a potential treatment for alcoholism and other ailments, as well as investigating its similarity to other psychedelics. It wasn’t until 1968 that the federal government outlawed these drugs due to their association with the cultural turbulence of the 1960s.

Today, several decades later, terminal cancer patients are once again taking psychedelics. This time around the drugs are being administered by doctors and scientists in controlled settings—and they are not microdoses. The results of this research have been nothing short of remarkable.

Laura Archera Huxley, 40-year-old musician and filmmaker, and husband Aldous Huxley, 61-year-old British novelist, pictured at their Hollywood home in Hollywood in 1956. On his deathbed seven years later, Huxley asked his wife for a massive dose of LSD.

Alleviating anxiety and despair

Terminal patients often suffer from feelings of intense anxiety and despair after receiving their diagnoses. For many, this is just too much to bear. The overall suicide risk for these patients is double or more compared to the general population, with suicide typically occurring in the first year after diagnosis.

Terminal patients have twice the suicide risk of the general public. Psychedelics may help reduce their fear and suffering.

That’s where psychedelic therapy may help. After a single large dose of psilocybin, taken in a curated space and supervised by a pair of doctors, many patients report feeling reborn. It’s not that the underlying physical disease has been cured. Rather, the drug prompts a shift in the theme of their emotional self-narrative—from anxiety and despair to acceptance and gratitude.

It may seem curious to think about psychedelic drugs, often associated with hippies and the Grateful Dead, as clinical-grade tools for overcoming our primordial aversion to death. But maybe it shouldn’t be. Maybe this is only surprising if your window of historical perspective is too narrow. Maybe these “novel findings” are, in a sense, a return to somewhere we’ve been before.

Psychedelics at the dawn of civilization

In late 2020 I spoke to Brian Muraresku, author of The Immortality Key: The Secret History of the Religion With No Name, about the use of psychoactive plant medicine throughout antiquity. Our podcast conversation covers this history in more detail, but it’s clear that humanity’s relationship with psychoactive plants extends back at least to ancient Greece—if not further. It’s hard to look at prehistoric cave paintings like the Tassili mushroom figure and not wonder if psychedelics played a part in their creation.

Western philosophy may have developed with help from psychedelics as well. In Plato’s well-known allegory of the cave, a group of prisoners live chained to a cave wall, seeing nothing but the shadows of objects projected onto it by fire. The shadows are their reality; they know nothing outside of it. Philosophers, Plato states, are like prisoners freed from the cave. They know the shadows are mere reflections, and they aim to understand deeper levels of reality.

Plato’s philosophical ideas might have been influenced by psychedelic experiences.

Was Plato tripping?

If that sounds like someone who’s explored those deeper levels with psychedelic assistance…well, maybe it was. In his book, Brian Muraresku explores the significance of the Eleusinian Mysteries, secret ceremonies that involved death and rebirth. For centuries, philosophers and mystics traveled to the Greek town of Eleusis to partake in a ritual that involved an elixir known as pharmakon athanasias, “the drug of immortality.”

“Within the toolkit of the archaic techniques of ecstasy–plant medicine just being one among many–something you find again and again, in Ancient Greece and other traditional societies, is this sense that to ‘die’ in this lifetime, or achieve a sense of timelessness in the here and now, is the real trick.” -Brian Muraresku

Contemporary archaeologists, digging outside Eleusis, have unearthed ancient chalices containing a residue of beer and Ergotized grain. Ergot is a fungus that grows on grain. It produces alkaloids similar to LSD. It’s possible, then, that influential thinkers like Plato were inspired by genuine psychedelic experiences.

This connection between psychedelics and death didn’t end with Eleusis. It survived, often repressed and hidden from view, right through the time of Aldous Huxley.

The connection re-emerges in the 1960s

In the 1960s, Timothy Leary co-wrote a book called The Psychedelic Experience: A manual based on the Tibetan Book of the Dead. Leary, the exiled Harvard professor and psychedelic guru, dedicated the book, “with profound admiration and gratitude,” to Aldous Huxley. It opens with a passage from The Doors of Perception, Huxley’s essay on the psychedelic experience. Huxley is asked if he can fix his attention on what the Tibetan Book of the Dead calls the Clear Light. He answers yes, “but only if there were somebody there to tell me about the Clear Light.”

It couldn’t be done alone. That’s the point of the Tibetan ritual, he says: You need “somebody sitting there all the time telling you what’s what.”

Huxley was describing a trip sitter, someone who guides a person along their psychedelic journey. Sometimes it’s an ayauasquero in the heart of the Amazon. Sometimes it’s a doctor holding your hand in a hospital.

Timothy Leary, shown at home in California in 1979, was deeply influenced by Huxley’s work.

Seeking rebirth within the mind

In his book, Leary grounded Eastern spiritual concepts in the understanding of neurology we had at the time. The states of consciousness achieved by meditation masters and those induced by three hits of Orange Sunshine, he wrote, may actually be the same. Both involve dissolving the ego (“death”) and allowing it to recrystallize as the default mode of consciousness returns (“rebirth”). 

Leary wasn’t talking about magic. Scientists know these as “non-ordinary brain states,” inducible by rigorous attentional practice (meditation), pharmacological intervention (psychedelics), and organic decay (dying).

The ability of psychedelics to induce these remarkable brain states may also be why they’re showing such promise in alleviating the very ordinary fear of death.

Today’s psychedelic treatments: Coping with death

So what, exactly, has recent research on psilocybin as an end-of-life anxiety treatment involved?

A few small studies have seen psilocybin administered to dozens of cancer patients. They’ve been conducted in a randomized, double-blind, placebo-controlled fashion. In general, a large majority of patients showed sustained, clinically significant reductions in measures of psychosocial stress and increased levels of overall well-being.

For example, in one study, 80% of the patients found that a single dose of psilocybin quickly relieved their distress. Remarkably, in some patients that positive effect lasted for more than six months.

Sprouting new physical connections

What’s going on at the neuronal level to produce those changes? We don’t know for sure, but some preclinical research has given us a hint. Both psilocybin and LSD have been shown to induce rapid and lasting antidepressant effects in lab animals.

Early studies hint at how psychedelics may produce positive changes in the brain.

Early indications are that psychedelics may allow brain circuits to rapidly sprout new physical connections. This is exciting, but again: These are non-human studies, and it’s early.

It’s gratifying to see any of these studies happening, frankly. This is research that’s been stalled by the Schedule I status of psychedelics for half a century. Much of this work requires obtaining a special federal waiver to study banned substances, which slows progress.

Potential help for end-of-life patients

Fortunately, the FDA recently designated psilocybin therapy as a “breakthrough therapy” and the DEA has proposed increasing the supply of psilocybin for research. This should speed up the rate at which we understand the clinical efficacy of psilocybin and related psychedelics.

Here’s more good news: In terms of psilocybin’s efficacy as a treatment for end-of-life anxiety, larger human trials are already underway.

Dr. Stephen Ross, one of the field’s leading researchers, has described the significance of this work: “If larger clinical trials prove successful, then we could ultimately have available a safe, effective, and inexpensive medication—dispensed under strict control—to alleviate the distress that increases suicide rates among cancer patients.”

Huxley: Ahead of his time

In one sense, Aldous Huxley was ahead of his time. More than a half-century before today’s renaissance in psychedelic research, his own experiences had evidently brought him to the conclusion that the best way to experience death was in a psychedelic trance.

In another sense, though, Huxley was one in a long line of creators stretching back to ancient Greek philosophers and perhaps even to prehistoric cave artists. They may all have used psychedelics to catalyze their outward creativity and comfort their inner distress.

Huxley titled his famous introspective essay, The Doors of Perception, after a quote from the English poet, William Blake: “If the doors of perception were cleansed everything would appear to [us] as it is, infinite.”

We will never know what he experienced in the final hours before his death, after handing that note to his wife. I like to think that for him, the last breath seemed to last forever.

Complete Article HERE!

Euthanasia Du Jour?

Doctors’ Hidden Truth On End-Of-Life Care

Amid an ongoing public debate in France on end-of-life palliative care, doctors tell Le Monde how they secretly help their patients die.

By Laetitia Clavreul

As the president of a doctor’s union says of treating the chronically ill, “We’ve all pushed the syringe” at some point in their careers.

Death is a topic that doctors rarely discuss among themselves. Too heavy, too personal. Instead, these things tend to be between attending physicians and their patients, who they follow until their very last minutes.

French President François Hollande has promised a draft bill on end-of-life assistance, and the role doctors play for chronically ill patients is at the heart of the debates. Some have agreed to tell us about their practice, whether anonymously or using their names.

“Doctor, will you help me?” The question is sometimes asked when the end of life is not that near. “I tell them that I am not the right doctor for that,” says doctor O., who has been a general practitioner in the west of France for the past 30 years. “I don’t claim to be the one to decide.”

But when the final moments truly have arrived, it’s a different story. He helps patients “go” when they are in pain, when life has become unbearable. Often, he says, “They do not voice any request. But when we touch their forehead with our hand and they are looking straight at us, they tell us with their eyes: ‘I’m ready.’”

He recalls a Saturday night at 11.30 p.m., when an entire family was holding vigil for a mother in pain and asked him to “do something,” because that was what she wanted. He repeated that he was not allowed to, that he could only increase the morphine dosage. “But I knew what the outcome was going to be,” he says.

Dr. Stéphane Pertuet, from the northern French town of Barentin, says a patient once asked him, “You’ll do what’s necessary, won’t you?” The patient was telling him he was scared. The doctor comforted the dying man, and said that he would.

Pertuet remembers a former military man, who made him promise not to hospitalize him “at the end,” and to do “what’s necessary” so he could die “in a dignified” manner. One day, when he was in a state of shock, he told the doctor, “Finish me.” “Of course, I didn’t do it,” Pertuet says. “But I made sure that he wouldn’t suffer by setting up a graded treatment, aware that it could kill him. If he felt that I was hesitant, it would have been a fiasco.”

Doctors use various drugs, all of them legal, to help ease a dying patient’s pain and usher them peacefully into death. Curare or potassium chloride would immediately lead to the death of the patient. But using those drugs would be a crime. What doctors can legally do is prescribe sedation to relieve suffering and agony. They can mix anxiolytics, morphine or other analgesics, leading to respiratory depression and death a few hours or days later. What the law forbids is “intentionally” causing death.

In the patient’s shoes

Words are important, says Dr. G., a general practitioner in southeast France. “Yes, I help people die,” he says. “Killing is different. It’s an immediate action. Increasing the dosage has nothing to do with euthanasia.”

When Pertuet arrives at the home of a patient he is treating, he doesn’t necessarily have a preconceived idea of what he is going to do, he says. “I suppose I sense that I will lead the patient to death, but I have no other choice. Otherwise, the patient suffers.” He tries to step into the patient’s shoes, taking into account his personality, culture and religion.

Bernard Senet, a retired physician working as a medical officer at an association advocating legalizing euthanasia, has worked in private practice and also in a palliative care environment. When patients are suffering agonizing pain, Senet says it is his duty to help them.

“When the patient is uncomfortable despite the morphine, we open up the automatic syringe and it all goes,” he says. Once or twice a year over the course of his career, he has found himself in this kind of situation, and it is no doubt the case for other physicians too.

In fact, he knows it is because he often receives calls from fellow doctors asking for his advice. “I’m not an exception,” he says. “For fear of judges, the others don’t want to say that we do it, in appropriate conditions, and that it’s never easy,” he admits. “But from the moment you stop the treatments, you know you are sentencing the patient to death. From the moment you dispense Hypnovel at the hospital, you know you will cause a respiratory arrest.”

“I assist until death”

Not every doctor is willing to assist their patients in death, but for the ones who do, they regard it as part of their job. “I remember my first assistance very clearly,” Pertuet says. “It is the quintessence of our commitment. It is then very important to be a good technician and a very good psychologist. But it always leaves a mark.”

Dr. R., a general practitioner specializing in palliative care near Paris, says he assists “until death, because death is part of life.” But recently, a seriously ill patient under 70 years old asked him if he would agree to give him “an injection.” Even if the law changes, the doctor says he would never go that far.

The law, in fact, is not necessarily at the heart of everyone’s concerns. Pertuet hasn’t really altered his handling of these cases over the years, he says. “I watch the debates between experts with amusement. They hide behind religious beliefs, sacrosanct ethics and palliative care. But for me, the more I think about it, the less sure I am.” What is important “is what they never talk about: humanity, technique, the doctor-patient bond.”

The French Leonetti legislation, passed in 2005, has made doctor G. more relaxed. “We used to be limited on a legal basis,” he says. “We couldn’t handle therapies when we knew we were at a lethal level.” Even the French medical college, which he characterizes as typically “quite retrograde,” last year announced its support of terminal sedation for patients with insurmountable pain, calling it “a duty of humanity.”

“It’s not a step towards euthanasia,” insists Dr. Jean-Marie Faroudja, ethics head of the national medical college council, pointing out the necessary commitment to the Hippocratic Oath. “Killing must remain prohibited.” He acknowledges that “between causing death and putting the patient to sleep until it arrives, the difference is narrow.” But it exists.

Complete Article HERE!

4 ways to improve the lives of older people

By Prakash Tyagi

  • By 2050, it is expected there will be more humans over 60 than under 15 for the first time in history.
  • Older people are harder hit by poverty and ill-health, necessitating better support structures be put in place.
  • The UN Decade of Healthy Ageing gives a framework for improving older people’s lives.

Population ageing and the resulting demographic transition around the world present complex challenges. It is estimated that the global population of older persons will rise by 56% between 2015 and 2030, from 956 million to 1.4 billion, and hit the 2.1 billion mark by 2050. Between 2015 and 2050, the proportion of the 60+ age group globally is expected to rise from 12% to a staggering 22%. People over 60 will outnumber those below the age of 15 for the first time in history.

The transition is rapid and dramatic, and uneven in different parts of the world. While it took France about 150 years to rise from 10% to 20% of the population being older than 60, a similar transition will occur India, China and Brazil in about 20 years. In high-income countries, the proportions of older people have been rising gradually, with over 28% of Japan’s population already being over 65 years of age.

The proportion of older people worldwide is ageing
The proportion of older people worldwide is ageing Image: UN

Large numbers of older people, particularly in lower- and middle-income countries, live in severe poverty and in poor health, with no or limited access to basic health services and social protection benefits. There are gender disparities too, with older women experiencing greater deprivation. Research suggests that in sub-Saharan Africa households headed by older women live in greater poverty compared to households headed by men of equivalent age. Furthermore, the correlation between ageing and disability is clear, with over 46% of older people worldwide living with some form of disability. Over 250 million older people have moderate to severe disabilities. These numbers are likely to rise further, causing more hardship.

This significant demographic transition means there is unprecedented need for age-friendly and responsive healthcare systems and a range of coordinated services to address the complex needs of this ageing global population.

The proposal of observing a Decade of Healthy Ageing from 2021 to 2030 was adopted by the UN General Assembly last December. This global collaboration is led by the World Health Organization (WHO) and will bring together governments, civil society, international agencies, professionals, academia, the media, and the private sector, in alignment with the Sustainable Development Goals (SDGs).

To foster healthy ageing and to improve the lives of older people, the Decade of Healthy Ageing will focus on four action areas. The first is to create and strengthen age-friendly environments by removing physical and social barriers and by converting them into better places to live and to age. The second is to combat ageism: Older people, despite their significant contributions to society, are often overlooked and subject to prejudice. Such stereotyping and discrimination must be addressed.

The third is to provide integrated care. All older people should have non-discriminatory access to integrated care, which should include but is not limited to: prevention, promotive, curative, rehabilitative, and palliative and “end of life” care – which must be safe, affordable and of good quality. The fourth is to support long-term care (LTC). With significant decline in their mental and physical capacities, many older people are unable to live an independent life or to actively participate in society. Hence, access to good LTC services is essential to maintain their functional ability, to ensure that they enjoy basic human rights and that they live a life with dignity.

Numbers of older people above 60 by world regions
Numbers of older people above 60 by world regions Image: UN

Four further enablers will be critical to the Decade of Healthy Ageing: engaging directly with the voices of older people; leadership development and capacity-building at all levels; connecting all stakeholders; and strengthening research, data and innovation.

The decade, its action areas and enablers lay out a solid framework to foster healthy ageing around the world. However, stronger efforts will have to be made into converting a theoretical framework into practical and measurable actions. To date, progress has been limited and further delayed by priorities imposed by the pandemic. On 1 October, International Day of the Older Persons (IDOP), which this year has a theme of Digital Equity for All Ages, is an important opportunity to take stock of what has been achieved.

Looking ahead, it may be worthwhile to categorize basic needs into groups. The first is to design a comprehensive communication mechanism and to deliver the decade of healthy ageing messages to all stakeholders, most importantly to older people themselves. The sooner the information disseminates and is well understood, the more active the stakeholder participation should be.

A second key group of needs is to develop a strategy for partnerships that are going to be crucial in engagement of key groups, delivery of services and for research and advocacy. Civil society, government agencies and the private sector are three important constituents of the partnerships spectrum, and a clear plan for involving them must be developed at both macro and micro levels.

A third is to create guiding groups at national level (and at provincial or sub-national levels too in the case of larger countries) comprising representatives from different sectors who can ensure dynamic planning, implementation and monitoring of actions.

Fourthly, the decade also provides an important opportunity to strengthen LTC services and improve integrated care – fundamentally important blocks of healthy ageing that require greater attention. Community-based LTC will have to be reinforced by promoting self-care and by training and capacity-building of formal and informal caregivers. Primary care needs must be addressed in remote and rural settings, assuring integrated care for older people. Existing models and past experiences from Help Age Global network and from organizations like GRAVIS in India may provide replicable insights. The knowledge accumulated by senior-age people’s organizations, especially how to strengthen intergenerational exchanges to ensure lifelong application of healthy ageing principles, is a valuable resource worth utilizing.

COVID-19-related challenges are already a hindrance and will likely continue to hamper progress on healthy ageing for many years. Mitigation strategies will have to be worked out in advance in the context of community education and delivery of care services using digital education, telemedicine and within COVID guidelines, keeping the local context and situation in view. Existing healthcare infrastructure overburdened by the pandemic will have to be used judiciously. Future of Work

What is the World Economic Forum doing about including older people in the workforce?

There is a global myth that productivity declines as workers age. In fact, including older workers is an untapped source for growth.

The world has entered a new phase of demographic development where people are living longer and healthier lives. As government pension schemes are generally ill-equipped to manage this change, insurers and other private-sector stakeholders have an opportunity to step in.https://www.weforum.org/videos/promoting-an-age-inclusive-workforce-living-learning-earning-longer

The World Economic Forum, along with the Organisation for Economic Co-operation and Development (OECD) and AARP, have created a learning collaborative with over 50 global employers including AIG, Allianz, Aegon, Home Instead, Invesco and Mercer. These companies represent over two million employees and $1 trillion in annual revenue.

Complete Article HERE!

How ‘Big Funeral’ Made the Afterlife So Expensive

It’s time to reevaluate the cost of death care—and its environmental impact.

By

“You can’t die these days because it’s too expensive,” Randy Hinojosa told Time last year. Hinojosa had just paid $15,000 for a funeral for his wife of 26 years, after she died of the coronavirus. Like thousands of families coping with unexpected pandemic funeral costs, he drained his savings and launched a crowdfunding campaign to recoup some of the losses. “I didn’t even want to ask anybody for money,” Hinojosa said, crying. “I had this pride that I could do this.”

The pandemic, which has killed 690,000 Americans and counting, has magnified the importance of swift, respectful disposition of the dead—and the untenable cost of doing business in the current system. In 2019, the average funeral cost $9,135, according to the National Funeral Directors Association. That included viewing and burial, but not dwindling cemetery space or big-ticket items like monuments and other grave markers. Even cremation, for decades promoted as a cheaper (and greener) alternative to burial, now averages $6,645.

These practices are not just financially devastating, they’re also environmentally calamitous. In addition to human remains, traditional burial puts an estimated 1.6 million tons of reinforced concrete and 800,000 gallons of formaldehyde—a chemical used in embalming and a probable carcinogen—into the earth each year. Cremation, meanwhile, generates an estimated 534.6 pounds of carbon dioxide per person—more than the per capita emissions of Afghanistan.

These harsh end-of-life economics have contributed to a crisis of funeral poverty in the US, says Victoria J. Haneman, a professor at Creighton University School of Law in Nebraska. Funeral poverty existed long before the pandemic and, without significant reform to both the funeral industry and to national and local systems of funeral aid, many families will continue to struggle with growing credit card debt and new personal loans amidst their crushing grief.

In the worst-case scenario, people will be forced to leave their loved ones unclaimed in county custody, where sheriffs, medical examiners, social workers, chaplains, and others will cremate or bury the remains. In the US, as many as 3 percent of bodies are left unclaimed each year, a number that has reportedly risen due to economic inequality, the opioid epidemic, and the pandemic.

Though the US has the resources to guarantee everyone a proper burial, they’re not evenly distributed. “We should not be normalizing the $9,000 as the average cost of a funeral,” Haneman says. “Not only is that staggering, it’s wholly unnecessary.”

For most of American history, people died at home, where they were tended to by loved ones. Women in the community prepared the body, while men made the casket. That started to change with the Civil War, where death occurred on faraway battlefields. Enterprising morticians subsequently popularized embalming, a preservation technique that allowed families to ship bodies long distances so those who died could be buried where they had lived.

Today, death is a $20 billion industry. (That’s similar to the total revenue for the global music business in 2019, or the market for meat substitutes.) In its most corporate and cynical forms, it’s marked by largely unchecked pricing, including markups as high as 500 percent on caskets. It’s also defined by decades of resistance to innovation, even as public attitudes toward death are shifting. In 2015, for example, one funeral conglomerate estimated that for every 1 percent of its customers who chose cremation the company lost about $10 million—a “problem” some morticians attempt to solve by selling families often-unnecessary services and products, from pre-cremation embalming to pricy urns.

Where many communities were once served by small mom-and-pop funeral shops, the death-care landscape has been transformed by shareholder-driven companies. Service Corporation International is the largest funeral services provider in North America, with over 1,500 funeral homes and 500 cemeteries in its portfolio, accounting for roughly 16 percent of the overall market share. Instead of lowering prices as it has scaled, SCI prices average 47 to 72 percent higher than those of its competitors, according to a 2017 report coauthored by the Funeral Consumers Alliance. The only people who don’t seem to mind are investors, whose stock is up 151 percent over five years. Thanks to the efforts of Big Funeral, the industry holds a monopoly on the afterlife—and it’s pricing people out of dying.

But reining in these profit-driven companies has proven difficult, as their practices are often supported by local statutes. For example, two-thirds of states have onerous “ready to embalm” laws that require funeral directors to have access to an embalming room, even if they don’t want to offer the service or families don’t request it. These regulations persist despite the fact that embalming isn’t necessary in the case of cremation, which half of Americans now choose, and that green burial grounds—an increasingly popular choice among the eco-conscious—typically forbid the practice in order to prevent contamination of the soil. In New York State, the cost to maintain such facilities is passed on to consumers (in the form of higher funeral prices) to the tune of $25.8 million annually.

To date, the best efforts to curb these practices have come from the funeral consumers’ movement, spurred on by muckraker Jessica Mitford’s 1963 book The American Way of Death, which found evidence of widespread predatory pricing and disinformation in the industry. In the 1970s, the Federal Trade Commissions instituted its Funeral Rule, which requires that funeral service providers offer prospective customers accurate, itemized prices. Yet in 2020, the agency’s own undercover investigators found that roughly 19 percent of funeral homes they visited in five states failed to disclose adequate pricing information.

Part of the problem is that many people feel that the sticker price of a solid mahogany coffin or a ceramic urn reflects their love and respect for the dead. And even if they wanted to find a cheaper alternative, with so many Americans unable or unwilling to plan for their death, families are often left to organize and finance funerals under duress. It’s no wonder the majority of them will use the first funeral home they contact, without conducting a price comparison.

While business as usual remains clearly exploitative, it’s hard for many Americans to envision an alternative. But death care doesn’t have to be so commercialized, says Joshua Slocum, executive director of the Funeral Consumers Alliance. “That is not a natural law.”

Today, the federal government, as well as many state and local agencies, provides some assistance to families who might otherwise struggle to bury their kin. But these funds are not always accessible, and reimbursement is typically meager. In 2020, for example, the Social Security Administration set the cap on funeral grants to $255 a person—and it issues aid only to select heirs.

That’s what made the Federal Emergency Management Agency’s decision to reimburse the families of people in the US killed by Covid-19 up to $9,000 for funeral costs so unprecedented. While FEMA has provided burial assistance in the wake of natural disasters before, the pandemic relief effort is of a different magnitude. As of September, FEMA has awarded over $1 billion to more than 165,000 people.

FEMA’s remarkable support should have been a model for federal funeral assistance, with or without disaster, for decades to come. But by doling out aid without any attempts at environmental, economic, or other reform of the funeral industry, the program effectively subsidized it. “We had this fantastic opportunity to use this moment to not only pay for death care but to also promote environmental initiatives and innovative death technology,” Haneman says. We failed.

Even so, the pandemic has encouraged many people to reconceive death care as the end point on the continuum of health care, says Philip Olson, a technology ethicist at Virginia Tech who studies death. Funeral directors are now seen as #LastResponders who pick up where doctors left off. In an ideal world, both kinds of care would be universally accessible and focused on quality, not profit.

In 2016, Olson ran for the board of directors of the Funeral Consumers Alliance. He made government-funded death care his platform, but the idea of a socialized system was one few in the organization were willing to broach. Some consumer advocates worry that universal death care will inevitably benefit the funeral industry, whose worst practices they aim to curb. (“Big warning flags go up in my head when I hear ‘subsidy,’” Slocum told me, adding, “is that charity for the family, or a subsidized profit to the funeral home?”) But Olson still believes that funeral costs could and should be covered, perhaps through a future expansion of Medicare, a federal health insurance program primarily for Americans 65 and older.

Medicare is funded by several sources, most notably the payroll taxes of those currently in the workforce. That money is used to cover hospital, skilled nursing, and hospital services for enrollees, as well as some outpatient services and prescription drugs. Olson says taxpayer dollars could be distributed to ensure minimum coverage for funeral expenses, too. If health is a human right, as the World Health Organization claims, the dignified treatment of human remains should be, too. In the end, Thanatos comes for us all.

There’s some international precedent for such a system: In Sweden, every resident is guaranteed a funeral service and burial or cremation. In 1990, the government instituted a burial tax calibrated to the area in which someone lives (and presumably dies and is buried), as well as their income level.

When a Swede dies, their family automatically receives space for storing and viewing the body, a ceremony hall free from religious symbols, a grave or equivalent in a public cemetery for 25 years, coverage for the cost of burial or cremation, and some limited transportation. Other items, such as a coffin or urn, tombstone, funeral officiant, decorations, and reception, are not included. Nonetheless, the average cost of a funeral in Sweden in 2014 was just $2,897.

Right now, the Biden administration is advancing a law that, if passed, would allow Medicare to negotiate prescription drug prices. In the same way, universal death care coverage could negotiate the cost of coffin prices and other funeral services and supplies. While not everything could (or should) be covered, the essentials would be guaranteed to everyone. The government could also make it a point to incentivize green death care options, including natural burial, aquamation, human composting, and mushroom suits. In the process, Olson says it could lead to a sizable shift in power by challenging the primacy of what he calls “funeral industrialists” (funeral directors, cremationists, cemetery managers, and others) and biomedical experts, and raising up advocates of alternative approaches like home funerals, DIY caskets, and more.

“There are other ways of thinking about ourselves, not just as funeral consumers,” Olson says, “but as mourners, grievers, as members of a society in which the management of the dead is a social necessity.”

Complete Article HERE!

How My Son’s Tantrum Helped Me Grieve My Pregnancy Loss

By Isabelle FitzGerald

Two months after the baby I was expecting died in utero, I was late to pick up my kindergartener. We lived in Brooklyn, but Henry’s school was in Manhattan, and our evenings were often rushed. I took the school’s front steps two at a time, my whole body an exhausted ache. I longed to tuck my two children into bed and attempt, once again, to sleep.

In the lobby, Henry raced over to me, chattering about something he’d made in art class that he wanted to show his dad. I wasn’t listening. I was too busy wrestling his parka onto his wiggly body, my patience thin as a blade. His backpack flapped open. Homework sheets scattered across the floor.

Don’t snap, I thought.

Since the miscarriage, insomnia left me frayed. My fatigue was even more intense than after my children’s births. Technically, I was postpartum again, but instead of tending to a newborn, I was awake nursing a visceral sadness.

I hurried Henry outside. He stopped in the middle of the sidewalk.

“I forgot my paper airplane in the art room.” He demanded we go back. I said no. He protested. “It’s going to be thrown out!”

So that was what he wanted to show my husband. We were already late for dinner. He needed food, and I needed rest. We were not turning around for a folded piece of printer paper. “I’m sorry,” I said. “We have to go.”

He started wailing. I gripped his wrist, kept walking. Pedestrians stared. I reached for words to end the tantrum before we squeezed onto a crowded train. Our home across the river felt like an ocean away.

I know!” I said. “Let’s make another airplane.”

My suggestion only made him cry harder. “But I loved THAT airplane.”

Recognition struck my core: My little boy was grieving.

Fifteen weeks into my third pregnancy, after my husband and I announced our news, a routine ultrasound revealed ghastly stillness. Before, there’d been the steady flicker of a heartbeat, the bright outline of a baby sucking her thumb. Now a grey orb bobbed in darkness.

After a procedure to complete the miscarriage, the surgeon instructed me to lay low. My body recovered quickly, but my heart remained raw. In bed, all I could think about was the baby. I was eager to return to my routines, hoping they’d help me heal.

A week later, I went to a spin class. I imagined sorrow flowing out of my legs and into the pedals of the stationary bike. Afterward, a friend spotted me in the locker room. “How’s pregnancy going?” she asked.

“It’s actually not going,” I said, but the thumping bass obliterated my voice.

She made a sly joke about my fertility. “Three kids.” She winked.

“The baby died,” I shouted over the music.

Her jaw fell. The gazes of curious strangers prickled my back. Condolences tumbled from my friend’s mouth. My skin burned with the nauseating realization that wherever I went, I’d end up in this conversation.

Most people responded to me compassionately. Friends sent thoughtful texts and bouquets of flowers and a spread of smoked salmon and bagels. A few acquaintances admitted they had no clue what to say. I appreciated their authenticity. The most meaningful exchanges were with women who shared similar experiences. Grief pulled me along in its dark tide, but their stories glowed, lanterns along the shoreline that might eventually guide me back to land.

Yet for everybody who responded graciously, there were others whose reactions made me wish I’d never ventured outside. They glossed over what I was telling them like they were attempting to ignore an off-color joke at a dinner party. They minimized the loss: “At least you already have two kids.” They bypassed it: “You’ll get pregnant again.”

I don’t think they meant harm, but I walked away hot with anger, even shame.

Shame around miscarriage is incredibly common, but what I experienced wasn’t the shame I’d heard other women describe, the feeling that my body was defective. It was social shame. My misfortune made people squirm. Their responses suggested that my grief was intolerable – not for me, per se, but for them.

Weeks passed, and I expected to feel less tender. Instead, I stared at the backs of my eyelids each night, desperate for sleep, fretting over who I might run into the next day, what thoughtless thing they might say.

On the subway platform, Henry kept crying. By suggesting he make another airplane, I’d said the equivalent of: “You can try again.” Not only was I unable to make his sadness disappear, but my attempts to quiet him implied that I found his feelings burdensome.

My shoulders softened. I knew what I needed to do.

On the train, Henry nestled on my lap. I stroked his hair, resisted the urge to shush him, cheer him, offer solutions. Anguish doesn’t need to be fixed. It needs to be seen, heard, held. Every so often the sobs lulled, but then he’d shudder, and they’d start again. His tears didn’t peter out until we pulled into our stop.

Brooklyn was quiet. For several blocks, we walked in silence. I started thinking about the baby, about the women who’d also lost babies, and the solace I’d taken in their stories. An anecdote I thought he might appreciate popped into my head. “When I was younger, I lost something I was proud of, too.”

“What did you lose?” he asked.

“My computer crashed. Every paper I’d ever written was gone.”

He looked up. “What did you do?”

“I was so sad that I didn’t write for a long time,” I said. “Eventually, I started again. I still miss what I lost, but I’ve made other things that make me proud.”

Henry asked a few more questions about the computer before launching into a story about recess. His brightness had returned – for now. He slipped his hand into mine. We turned the corner for home.

I used to believe grief was innately isolating. Now I understand it is an opening, if only we are willing to see others in their distress and allow them to see us in ours. Eventually, the process of spreading my news would end. A day would come, sooner than I imagined, when I’d only have to discuss the miscarriage with people who wanted – or needed – to hear about it. I would light my own lantern, a beacon offered to other suffering women. In the meantime, moving forward meant releasing my concerns about how my loss made others feel. I was so hurt by a handful of tactless remarks that I’d shut out not only insensitivity but also genuine consolation.

When my husband got home, Henry realized again that he’d never get to show the airplane to his dad and his tears returned. I fought my urge to placate him. A paper airplane was a minor thing, but a child learning to grieve in a society where grief is relentlessly shunted aside was not. As I noticed the effort it took to hold my tongue, my anger toward the people who’d offended me began to dissolve. Sitting with my son’s pain was, in fact, painful. I was not a perfect witness, either, but I would keep trying.

“Tell me what you loved about your airplane,” I whispered while I tucked him in. He described the green teeth zigzagging along the fuselage, the second set of wings.

I wrapped my arms around him. Soon, his breathing steadied, and he drifted off to sleep.

For the first time in months, I did, too.

Complete Article HERE!

Death’s Price Tag: An inevitable trauma

By Judas Cote

In the spirit of October, I figured I should speak on a topic I’m passionate about, as someone considering end-of-life care as a career (I gag at the connotation of making a career of death care, but such is the nature of capitalism): the funeral industry. Let that phrase sink in for a second: Funeral. Industry. Death that generates financial capital. Death, a necessary and inevitable part of the human experience, costs and generates money.

Death is a tough subject, and for good reason. It’s a reminder of all of our mortalities, and that’s a lot to be confronted with, especially considering how capitalism makes us proletarians believe that we’re inhuman, that we’ll simply be exploited for an indeterminate amount of time, and then disappear from relevance. This alienation from mortality and personhood diminishes the depth of life brought about by our own mortality, and then, once confronted with it, the capitalist robo-proletarian illusion shatters, bringing great distress but no room to heal from it due to the standard 9 to 5 workday and low wages.

Let me step back and explain what I mean by this though. Many people work some variation of an eight hour shift job. If they’re full time, that’s about 40 hours per week, sometimes more, which leaves one or two days off. The Ford model of the work day is supposed to be eight hours of work, eight hours of leisure, and eight hours of rest. This treats human needs as if they were easy to standardize. It takes no account for commutes, obtaining and preparing food, the amount of sleep an individual needs to function, or difference of ability as this does vary widely in the working population. Some people forfeit another one of these eight hour blocks, working two jobs to make ends meet. How much time does that leave for the necessities: nourishment and sleep? Not much. How much time does that leave for self-actualization? Barely any. So how much time does that leave to process grief specifically? Almost none. Capitalism forces us to go about our lives broken and exploited, many without the means to mend our psyches due to the high cost of mental healthcare (and healthcare in general).

Funerals with bodies are considered the standard of funerary action in the United States. Between the funeral ceremony and the embalming/preservation of the body, costs can surge to thousands of dollars just to make this arbitrary ceremony.

Now to the funeral industrial complex. Think for a minute—what would you consider a dignified burial for a loved one who left behind no death plan? Maybe cremation, maybe burial in a casket, but not much else. Cremation is the cheaper option, and embalmed casket burials are often expensive. Not only do they take into account the labor from the funeral home for a service, but also the labor of embalming (which is widely overused in the United States due to its popularity in the Civil War for the transport of the bodies of soldiers) and the price of the casket and headstone. Caskets run around $1,200, give or take, and funeral homes often mark them up to generate profit. Headstones vary widely but can run from around $65 to over $200 . This doesn’t take into account any markups from manufacturers either. Plots can run around $350 to $5,000, embalming costs upwards of $500. Add in flowers and concessions and you get an idea as to why traditional American funerals are so expensive.

So, I would like to talk about some alternatives. Firstly, there’s donating your corpse to science (which is my plan). This involves one’s body being brought to whatever scientific institution needs cadavers (medical schools mainly) for educational use, and then discarded in mass graves afterwards. There are no direct costs with this approach, but you can always hold a service for a loved one who donates their body, just without their cadaver. There’s also natural burial, either in a plain shroud or one with a seed pod. Connecticut has multiple natural burial grounds around the state. Better Place Forests prices ceremonies based on the memorial tree you want, starting at around $5,900 for the cheapest option. Depending on the grounds you choose, prices will vary, and without a tree the burial would be cheaper as well. Other options include Aquamation (which is legal for humans and pets in Connecticut, for those concerned with eco-friendliness) and feed blocks (mixing cremated remains into feed blocks for woodland animals).

So, what changes do I think need to be made?

I think that funerary and end of life care should cease to be an industry; just as medicine, infrastructure, internet, plumbing and the like should cease to be industries. A shift in governmental values from those serving the class with the highest accumulation of capital to serving the working class. A shift towards democracy centered on proletarian needs. A shift to a human collective-centered culture, rather than a profit-centered one. Replace dog-eat-dog with camaraderie. Truly place power in the hands of the people, and build a world of collaboration and healing.

Complete Article HERE!