‘We Run Pet Hospice Care For Dying Animals’

Dr. Shea Cox is a vet who helps support pets with hospice and palliative care.

By Dr. Shea Cox

I didn’t grow up with pets but I remember wanting to be a vet since I was 8 years old and working on my stuffed animals as if they were patients. I went into college wanting to be a vet but I failed chemistry three times and ended up going to art school.

In 1991, I moved to LA on a whim. I was broke and looking for a job and ended up working in a nursing home. That led me to nursing school and chemistry started to click. I worked in areas of home hospice and palliative care. That dream never left and I began to think that maybe I could be a vet.

I started taking my prerequisite classes for vet school, and I continued nursing actually to pay my way through vet school. I finally graduated vet school in 2001 and went directly into emergency and critical care.

I spent 13 years working in a veterinary ER​, and during this time, our care evolved and we became a specialty hospital with internal medicine and oncology​. I started to see that during the most critical time in people’s relationship with their pet, when pets were ill or had multiple comorbidities, people would need more time to process complex issues and decisions and they weren’t getting it. We would diagnose their pet with cancer in the ER and people would be left in that state of shock.

I felt like we were failing, and I decided I was going to start offering services strictly focused on hospice and palliative care for pets. But in 2012, when I started offering three hour in-home appointments, people told me that the idea wasn’t financially viable. I said I was going to try. I felt in my heart it was what people and pets needed.

My first hospice patient was a dog named Sunny. Sunny was brought into our veterinary ER with multiple urinary issues by her owner’s fiance, because he was in Colorado at his father’s funeral. I did an exam and discovered it was a tumor that was blocking the urethra so the pet wasn’t able to urinate. It was a situation that is technically one where we would euthanise the animal. But I discovered that Sunny was the pet that had got the owner through his wife’s death. I so clearly remember being in the ER and finding all of this out about the owner and realizing that he could not come back to be with Sunny and say goodbye.

I ended up providing Sunny with an in-dwelling urinary catheter, something which should be in-hospital only. I remember others saying we couldn’t send Sunny home with this catheter, but the alternative was euthanasia, breaking this human/animal bond, not allowing the owner to say goodbye.

Sunny was able to go home and three days later the owner returned and they spent an amazing two weeks together. They managed the catheter and completed their bucket list. Sunny swam in the ocean with her owner and they had a huge party with other dog friends where they ate grilled filet mignon and had these “pupsicle” ice creams. We were able to facilitate a goodbye on the lawn of his house. To be able to create that kind of goodbye for someone, when the alternative would be so different, was life changing for me as a person and a doctor. That is a situation that has lived with me and been my north star since I started this.

For me, hospice and palliative care begins at the time of diagnosis, when there are signs of decline in the pet, because there is so much we can do to improve quality of life and prepare the pet and pet parent. We have had pets in hospice for 18 month to 2 years, so that’s technically palliative care.

Hospice care is done in the pet’s home. We are under the umbrella of the Pearl Pet Hospice but our goal is to be that bridge between the hospital and the home. One of the things I found interesting early on in these 3 hour in-home appointments was that 75 percent of the care people needed help with was non-medical.

Families typically need help planning and goal setting for how they wanted their pet’s end of life to look, help deciding what their bucket list was going to be, whether they wanted a memorial. We discuss what they are struggling with and what their resources are. A lot of the topics are things vets aren’t typically able to address with families because there’s just not the time.

When a family enters their pet into our hospice program, they have an entire team on their side to support them every step of the way. Families work with me, a dedicated nursing team, care coordinators and pet loss support specialists. During our in-home appointment, we educate and empower the family, including in how to recognize signs of decline, how to give medications or injections, and how to monitor progression of their pet’s disease. Following this, the majority of our care continues virtually via telehealth where the family has 7-day a week access to their hospice team for guidance and support until the time of in-home euthanasia. Generally, the pet’s quality of life sky rockets, and the time to euthanasia is generally much farther out than what their pet’s diagnosis would dictate. I’m surprised every day by the difference we can make, and that just makes my heart so full.

Dr. Shea Cox and a Pet Patient
Dr. Shea Cox with Claire, a pet sibling to Sunny, the first animal she helped in hospice care.

The vast majority of my hospice patients are dogs and cats, it is a little more weighted towards dogs, which is surprising since cats don’t generally like to go into hospitals as much. I have had a couple of bird patients. When birds can live for 80 years, people are very bonded to them.

I have helped thousands and thousands of pets in hospice care. I have been doing this close to 10 years and as we have grown as a team, we’ve been able to affect a lot of lives, which is amazing.

Over the past 10 to 15 years I think the human/animal bond has changed dramatically. Millennials are now the largest pet owning population and their pets are their children. When I started this in 2012 in the Bay Area of California, there were four other practices doing something similar. Now I believe there are close to 30. That area may have a unique demographic that supports that but I am seeing this trend across the country.

Pet hospice care is growing pretty rapidly. It has been widely known for around 10 years and in the past five years there has been a large increase of practitioners. The International Association of Animal Hospice and Palliative Care (IAAHPC) is an organization where in the earlier days there were just a couple of hundred of us and now there are close to 2,000 members.

People often say they wish they had known about this for their last pet, or
sooner, and that’s something I want to erase from people’s thoughts. I want everyone to know this is available. The other thing I hear a lot is people asking me how I can do this every day, because it must be so sad and make me depressed. Oddly it’s just the opposite. I spent 13 years in the ER doing everything I could to save lives and I have never been so gratified as being able to end them well. People are so grateful that you are taking the time with them and being caring during one of the most intimate times in their relationship with their animals. Of course, it is sad and I still get teary at every euthanisia, but I leave with my heart so full that it’s hard to say this is anything but the most amazing career in the world.

Complete Article HERE!

The Dead Get a Do-Over

In a flurry of streaming television shows, the departed get a second chance. And viewers find an outlet for sorrow and remorse.

As Cal in “Manifest,” Jack Messina returns from oblivion with supernatural gifts.

By Ruth La Ferla

In “Manifest,” a series streaming on Netflix, Michaela, one of the show’s more candidly troubled characters, turns up with her companions after a lengthy, unexplained absence to be reunited with their families.

She ought to be ecstatic. But her reactions more aptly reflect the Kübler-Ross model of grief, some of its stages — denial, depression and anger — mingling on her features, along with a slow-dawning acceptance. As she tells Jared, her former fiancé, “Part of me wishes we hadn’t come back at all.”

Her response seems relatable. Mourning her life as she knew it, Michaela is one of some 200 passengers on the Montego Air Flight 828, who have mysteriously vanished only to return five years later, not a day older and sound of body but freighted with all manner of weighty emotional baggage.

In “Glitch,” Maria (Daniela Farinacci) resurfaces still caked in the soil from her grave.

That tale is but one in a rash of streaming series finding new audiences in the midst of a lingering pandemic, luring viewers with the suggestion that the boundary between life and death may be porous indeed. The departed get a new purchase on life in “Glitch,” an Australian offering in which the long-expired denizens of Yoorana, a fictional community in the Australian outback, stagger back to their homes, bodies still caked with the soil from their graves.

“The 4400,” focused on the undead but with none of the zombie horror effects, shows the newly risen wielding oddly assorted superpowers. In “The OA,” a fable-like iteration of the resurrection theme, the heroine has perished many times over, blind in one incarnation but gifted in another with an extraordinary second sight. Death itself is illusory, she assures a young school friend. “I think you are always somewhere.”

There is “The Returned,” an American adaptation of “Les Revenants,” a decade-old series about the long-gone members of a French Alpine village intent on picking up the shards of their lives, unaware that their near and dear have long since moved on. And “Katla,” an Icelandic production in which the deceased resurface in the shadow of an active volcano, seeking to salve emotional wounds.

At a time when people are grieving not only their dead, but lost jobs, opportunities and daily routines, the appetite for such fare seems especially poignant. Reveries, sci-fi fantasies or meditations on life’s great mysteries, these shows offer viewers little in the way of resolution but hold out a promise of redemption, reunion and, not least, a chance to muse on their mortality.

“Death has been a more omnipresent force in our lives in the last 18 months than it has been in our lifetimes,” said Steve Leder, the senior rabbi of the Wilshire Boulevard Temple in Los Angeles and the author, most recently, of “The Beauty of What Remains,” about the nature of bereavement.

“Death is no longer something we can banish to the basement of our psyches,” Rabbi Leder said. “It is that broomstick pounding on that basement ceiling, demanding: ‘What about me? Pay attention. I must be reckoned with.’”

Dr. Andre (T.L. Thompson) and Claudette (Jaye Ladymore) of “The 4400” beam down with a mission.

Such shows offer, as well, a chance for viewers to confront, or at least contemplate, their most nagging anxieties. “These shows are our version of a roller coaster, a death-defying ride with the things you fear most.” said David Kessler, whose most recent book, “Finding Meaning, The Sixth Stage of Grief,” explores the reverberations of loss.

“When people are grieving, one of their greatest fears is that they’re going to forget about the person they have lost,” Mr. Kessler said. “We don’t want to move on because that feels like abandoning those we love.”

There is scant chance of that in the latest shows, many of them defunct network series revived for streaming at an eerily opportune time. “We live in the world’s first death-free generation, meaning that many people live into their 40s before experiencing the death of a parent, sometimes even a grandparent,” said Alan Wolfelt, a death educator and grief counselor.

“In a mourning-avoidant culture such as ours watching these shows is, in part, a rehearsal,” he said. “They permit audiences to mourn and to acknowledge the reality of their own death.”

Yet they raise more questions than they can or care to answer. What makes us special? Do we, as in the case of “Manifest,” return with a mission or calling? Are there others like us? Are we in danger, or are we among the chosen? Will we get the chance of a do-over?

Matters of faith are underscored in “Manifest,” as when a startled passer-by drops to her knees at the sight of Cal, the youngest and most insightful of the Flight 828 returnees, chanting, “He is risen.” For people eager to regain some semblance of certainty in a disordered time, these stories exert a powerful pull.

“We’re a very mastery-oriented culture, always wanting answers,” said Pauline Boss, an emeritus professor of family social science at the University of Minnesota and the author of “Ambiguous Loss in a Time of Pandemic and Change.”

“With the spread of the virus, those answers are not necessarily forthcoming,” Dr. Boss said. “We don’t know if we can trust the person at the grocery store, whether or not they have been vaccinated. People are dying apart from their families, and those families may be feeling no sense of closure.

“What we have now is this whole host of ambiguous losses: loss of life, loss of jobs and loss of faith that the world is a safe place.”

“Manifest” will return for a fourth and final season, though Netflix has not announced a date. Peter Friedlander, who heads Netflix scripted series in the United States and Canada, said the series resonates with viewers because of their insatiable craving for mystery.

“It scratches that itch, trying in some way to hypothesize about the great unknown, to explore the notion of revisiting unfinished business,” Mr. Friedlander said. Such fare is a balm as well for people dealing with regret, he suggested, those eager to extract a message of hope from apparently meaningless, ungovernable events.

Sean Cohen, 27, a digital artist in Chicago who posts “Manifest”-inspired illustrations on Instagram, finds solace in the series. “It creates this whole story of how everything that happens is connected,” he said in a direct message on Instagram. There is also the emotional uplift, he said, “of seeing the passengers come together to help one another as the mystery unfolds.”

The show also captivates Princess Louden, 25, a dancer and graduate student in social work in Los Angeles. “‘Manifest’ technically is about something that could never happen,” Ms. Louden said. “It’s not like aliens are invading the planet. But it leaves a little room for all kinds of possibility. That’s what draws me in.”

The show is pure escapism, said Audra Jones Dosunmu, 52, a talent manager in the fashion and entertainment industries. “But there is also the idea that ‘There but for the grace of God go I.’”

“In a way I think of these shows as crisis pornography,’” Ms. Dosunmu added. “People like to see others going through things that they could never manage. But if that makes them feel thankful and better about their own lives, it’s a good thing.”

Many of the shows offer the tantalizing possibility of rescue and redemption, reassuring fans that, as is repeated like a mantra on “Manifest,” “all things work together for good. …”

In “Katla,” the dead, rise naked and covered in ash, a volcano erupts.

On “Manifest,” the risen heed inner voices urging them to acts of heroism. Michaela responds to a “calling” to free two teenagers trapped in a killer’s lair. In “Glitch,” a young woman sets out to confront her rapist and murderer. In “Katla,” estranged sisters, one of them dead, work at mending their frayed relationship; and in “The Returned,” a serial killer in a former life learns to rue and curb his lethal impulses.

These shows explore the prospect of a second chance, of tackling unfinished business, revisiting relationships, and dealing with regret, Mr. Friedlander said. “They let you look at the choices you’ve made and reflect on your priorities and values.

“It’s that sliding-door scenario that asks, ‘What if I could say one more thing to that person I’ve lost?’”

Complete Article HERE!

Understanding End-of-Life Options

— New Book Details Voluntarily Stopping Eating and Drinking

When supported by knowledgeable providers, the process can be peaceful and meaningful.

By Kelly Webster

Quality of life can diminish considerably for people living with incurable or terminal diseases. They have thoughts and questions about what the end of their life will look like. They may wonder about their condition deteriorating, losing their dignity and autonomy, and being a burden on their family members. They also worry about suffering. Sometimes, discussion turns to potentially hastening the end of their lives.

In a new book titled “Voluntarily Stopping Eating and Drinking: A Compassionate, Widely Available Option for Hastening Death,” University of Rochester Medical Center professor emeritus Tim Quill, M.D. provides realistic descriptions of what happens to a person when they consider and potentially choose VSED (voluntarily stopping eating and drinking). He addresses misconceptions of this poorly understood practice, which can cause people to inaccurately picture uncomfortable starvation and unrelieved suffering. The truth is that when undergoing VSED supported by knowledgeable and caring physicians, the process can be peaceful and meaningful.

“I have been engaged in research and discussions around medically assisted dying for many years. In New York State, physician-assisted death is not legal, but many terminally ill patients want and need help figuring out what their end-of-life options are,” said Quill. “VSED has been a legally available option in the background for some time now, but most people don’t know about it or fully understand it. We wrote this book to help physicians, patients, and families learn about the process from a clinical, legal, and ethical perspective.”

A Sense of Grief and Relief

Chapters from the book include several real patient stories including a contribution from Robert Horowitz, M.D., URMC division chief of Palliative Care. As a physician, Horowitz has extensive knowledge of end-of-life situations, including patients who have chosen VSED. However, he gained a unique perspective when his own mother who was facing a progressive illness wanted to discuss her future options.

At that point, she was in the early stages and had the capacity to make decisions, but she feared what would happen to her as the disease progressed. The last thing she wanted was to spend the rest of her days dependent, frail and lost in a nursing home. Now facing the situation as her son rather than her physician, Horowitz and his family held many powerful conversations with his mom and her physician. They ultimately agreed that when his mom decided the time was right—that living with additional losses incurred by disease progression was untenable to her—they would support her choice to die by VSED.

The term “grief and relief” appears many times throughout the chapters, because end-of-life can be distressing for both patients and families, but the assurance that a loved one will not suffer a worse fate is a blessing. Horowitz’s contribution to the book details his, his mother’s, and their family’s experience in a way that humanizes this medically and emotionally complicated situation.

Empathy is Key for Discussion

Both physicians and patients are often hesitant to bring up end-of-life planning because it is difficult to talk about, and because of legal and ethical concerns.

This book approaches the topic with a deep sense of empathy for all involved. When a patient and family begin to consider the road ahead, it’s important that they understand all options available, and receive comprehensive information to help them make fully informed decisions.

For a patient worried about their condition dragging on for months or even years, the desire to bring their lives to a meaningful end can bring closure for themselves and their families. The process of VSED usually takes approximately ten days to two weeks from initiation to death, provided the patient strictly adheres to the process. This gives the patient and family a very meaningful but finite period of time to come together, make final plans, and say farewell. For families and loved ones, the patient finally finding a peaceful escape can be a blessing.

The key for any end-of-life situation is open communication. This book can be a tool for opening up the conversation between family members, and/or for a patient to start a discussion with his or her physician. Without doubt, these conversations can be difficult. However, they can be made easier with the knowledge and compassion offered in this book.

Quill is world renowned for his progressive discussions around palliative care and end-of-life situations. In addition to his clinical role at URMC, he is also a board member of the Death with Dignity National Center in Portland, Oregon. In 2013, Quill was included on a list of “Hospice and Palliative Medicine Visionaries” by the American Academy of Hospice and Palliative Medicine.

Complete Article HERE!

I Cannot Heal My Children’s Grief, but I Can Help Them Name It

By Miranda Featherstone

In September, on one of the first days that felt like fall, we drove from our house in Rhode Island to my father’s house in Massachusetts to spend the weekend. It is still hard for me to write or say “my father’s house.” Until recently, it was “my parents’ house,” but my mother died in June after a short illness, and her simple gray purse no longer sits on the hall table.

From the moment we arrived, my 8-year-old seemed out of sorts: Everything we asked of her was a burden, every pleasant activity somehow disappointing. Children don’t generally tell us that they are grieving or worried. They often simply behave disagreeably to communicate discomfort or sorrow. (Adults are not always so different.)

That night I tucked her in. “It feels lonely without Grandmummy,” she finally confessed. “And I can’t stop thinking about death. About other people dying. Like Granddaddy.” What could I say? Same, baby. Same.

We are not religious, so I have nothing to offer my daughter by way of an afterlife, but even if I did, the reality is that her grandmother has left our world; she will never again read to my daughter on the sunny end of the couch. Death and loss are the great unfixable things: They must simply be endured.

I can offer my children kindness — and limits — when they are disagreeable. I can empathize and offer them language for their pain. But I cannot make death go away; I cannot heal their grief.

Over the coming weeks, families will gather to celebrate the holidays, and many of us will feel acutely the absence of a beloved face or voice. Crowded kitchens that once evoked comfort — or even a kind of comfortable strife — may become stark reminders of loss.

As we stumble through nostalgic rituals made strange by months and months of separation, caution, illness and death, grief may bubble to the surface. Despite our attempts to protect them, children are not immune to these pangs of sadness and longing — far from it. Their grief will rise alongside our own, and we must be prepared to help them make sense of it.

We ought to name — first for ourselves and then our children — the enduring shock of grief, without grasping for silver linings or platitudes. As parents, we must become more comfortable with the language of death. As researchers who study sex ed remind us of that subject, it shouldn’t be “the talk” but rather a series of small conversations woven into the fabric of family life. Death is not so different.

I see a dead blue jay on the sidewalk — pitiful and luminous — and my instinct is to avert my gaze and hurry my preschooler along. But really, the tiny corpse provides a relatively neutral opportunity to explain to him — gently, honestly — that all things die, that bodies can become so hurt or sick that they simply stop working and life ends.

The psychologist J. William Worden, critical of the popular five stages of grief theory, gives the bereaved four tasks instead: The first three are to accept the reality of the loss, experience the pain of grief and adjust to an environment without the person. The last task is to find an “enduring connection” with the dead, perhaps by answering the question: What did the person give you?

I have suggested this project to my daughter, but it feels facile next to the relentless permanence of death. What if the fourth task takes you years? A lifetime? There is nothing straightforward about love whose object has been removed.

As Anastasia Higginbotham suggests in her wonderful picture book “Death Is Stupid,” another approach is to connect to the granular details of loved ones’ lives: “Wear what they wore. Play what they played. Read what they read. Make what they made.” It is excellent advice, but all the same, it will never be enough.

We talk of my mother often. We remind ourselves of her practical wisdom. (“Never pass up a bathroom!” “Where there is no solution, there is no problem!”) We consume books and movies — both ones that are funny and distracting and ones that mirror our loss, make us feel less alone.

I answer my 3-year-old’s incessant questions with friendly, age-appropriate frankness. “She died. We’ll never see her again.”

“Her body stopped working, and we had it cremated. That means it was put somewhere very hot and turned into ashes. She couldn’t feel anything. You can’t feel anything when you’re dead.”

“Mostly, people die when they are old. She was very sick, but it’s not like when you are sick with a cold. You get better.”

And, perhaps most important, “I miss her.”

Caregivers should initiate such direct conversations throughout the process of loss and grief. When a loved one becomes ill, we must speak to kids frankly about what to expect. Disfigurement from illness, perhaps. The person’s confusion or silence. And then death and its accompanying rituals of mourning. “We will all sing her favorite songs together. Some people will read poems, and some people will talk about Grandmummy. Then we’ll have snacks she liked. She won’t be there, but we’ll all be remembering her and celebrating her life together. It might feel sad, and it might feel nice, too.

It’s OK, as the adult, to shed tears through these conversations. It can help to spell out that sadness is universal and survivable: “It might seem scary or strange to see me cry. But everyone cries sometimes, and crying can even help us feel better. I promise I won’t cry all day. A cookie and a hug from Papa will help.”

As holidays loom, we might suggest to children, gently, that Thanksgiving without a beloved family member may feel strange and sad. With such foresight, they are better equipped than they might have been, certainly. But doing and saying the right things will not make the death of a loved one painless. Grief will be unimpressed by our developmentally appropriate phrasing. It will still hurt, and that’s OK. Parenthood, after all, is a series of repeated exercises in learning when to step in and when to sit back. When to problem-solve or protect and when to say, “This stinks.”

My daughter doesn’t expect me to fix her grief — she is not fully acclimated to our cultural habit of smoothing over misery — but, oh, how I wish I could. Instead, I can tell her that I am hurting, too. That pasta with tomato sauce and Parmesan cheese is still delicious and our kayak still cuts beautifully through the cold autumnal water. That I love her and that we will both always love my mother. That sorrows cannot always be escaped but they can be named and endured. That I will always listen to her woes and that saying them aloud sometimes helps — but that sometimes it doesn’t. That fearing the death of loved ones is a deeply human pastime. And that longing for someone gone is perhaps one of the hardest parts of being a person.

Complete Article HERE!

I’m a hospice nurse and this is what most people say before they die

By Tiffany Wallis

A hospice nurse has revealed what most people say before they die as she spoke out about how we end our lives.

Julie, a registered nurse from Los Angeles, California, has worked in a hospice for around five years.

The nurse has been using her expertise and knowledge to educate her 372,400 TikTok followers about death.

And her heart-warming comments as well as her love for her job have led to her videos going viral with people desperate to know about what to expect when they pass away.

She said: “I love educating patients and families about what to expect with hospices and what to expect with the specific disease they are dying from.

“I also really like giving the patient and family some comfort knowing we will be there to manage their symptoms.

“I have worked as a hospice nurse for about five years and before that, I was an ICU nurse for nine years so I’ve been doing this type of work for 14 years.”

Julie, who shares an insight into her job and answers burning questions everyone wants to know about hospices on her TikTok channel, said her aim is to educate others.

She recently posted a video about the normal things that happen to most people at the end of life — that look abnormal, but are actually really normal.

Julie explained that changes in breathing, changes in skin color, terminal secretions and fevers, just to name a few, are all normal stages.

She said: “The best part about my job is educating patients and families about death and dying as well as supporting them emotionally and physically.

“Also, helping them to understand what to expect is another part of my job as a hospice nurse.

“There is something most people say before they die and it’s usually ‘I love you’ or they call out to their mom or dad — who have usually already died.”

Julie said it’s difficult to explain what happens when people die — generally — as everyone is different.

But at the end of life, if someone is dying naturally in hospice care, most people show the same signs and symptoms.

This is called the actively dying phase.

Julie explained: “The symptoms of the actively dying phase include changes in consciousness (unconscious), changes in breathing, mottling and terminal secretions.”

“These are normal and NOT painful or uncomfortable.”

“Our bodies take care of ourselves at the end of life — the less we intervene, the better.”

There are also some common assumptions that people make about hospices but Julie explained that they’re not true.

She said it’s “not true” that everyone in hospices dies right away and it’s also not true that morphine makes people die faster.

Julie added: “There are some assumptions that people make. Another one that’s completely not true is that hospices kill people.”

Six months ago, Julie decided to share her knowledge of death and dying on social media — and said she couldn’t believe how quickly she went viral.

And the response has been incredible — she regularly shares informative videos answering people’s burning questions about death, dying and the happenings of hospices.

She said: “I knew I had a lot of interesting information about death and dying that most people don’t know about. I want to normalize death by educating people about it. I went home to visit my family, and my tween nieces were on TikTok making dance videos.”

“I later went on TikTok to see their dances. This gave me the idea of starting my own TikTok about death and dying, four days later I did it and it took off.”

“I’ve been doing it for six months now and have over 340,000 followers — it’s crazy!”

Complete Article HERE!

My father asked me to kill him

– As we age, more of us will face questions over assisted dying

A young Professor Luke O’Neill (centre) with his father before his stroke and his sister Helen

The immunologist Professor Luke O’Neill, author of ‘Never Mind the B#ll*cks, Here’s the Science’, reveals how his father asked for help in ending his life after a stroke, and reflects on how legal euthanasia works around the world

By Professor Luke O’Neill

My father asked me to kill him. He was 74, had suffered a stroke at 71 and couldn’t speak properly. He also had paralysis on his left side. He was a widower in a nursing home. We had tried home helps who came in every day, but he was also severely depressed, which made things difficult. He would say to me in his slurred voice: “You work in a lab. You have the chemicals to do it.” He also regularly said, “If I were a horse, you’d shoot me.”

My father, Kevin O’Neill, had a dark sense of humour, so I used to brush these conversations, but I knew he meant it. I would sometimes cry when I left him in his room, his own separate hell.

Should I, out of sympathy and love, have bumped him off? That would have been murder. But what if the law had allowed me to help him die? How would that have worked and would I have had the guts to do it?

Will a time come when euthanasia will be as routine as childbirth, as we head towards a population where the majority are sick and old, with lots of older people actually wanting to die? Or will the discovery of new treatments for diseases and better palliative care make euthanasia unnecessary?

The topic has been widely discussed in the UK again recently, with the Assisted Dying Bill being debated in the House of Lords. We must face this topic head-on.

Prof Luke O'Neill is an Irish immunologist (Photo: Ruth Medjber)
Prof Luke O’Neill is an Irish immunologist

Active euthanasia is legal in Belgium, the Netherlands, Luxembourg, Colombia and Canada. Assisted suicide is legal in Switzerland, Germany, the Netherlands, the State of Victoria in Australia and the US states of California, Oregon, Washington, Montana, Washington DC, Colorado, Hawaii, Maine, Vermont and New Jersey. It is illegal in all other countries, as is non-voluntary euthanasia (where the patient is unable to give consent).

Although legal in the countries mentioned above, it is only allowed under certain circumstances and requires the approval of two doctors and in some places a counsellor. Treatment or medical support being withdrawn because it is considered futile will also hasten death but is not illegal.

The Lords Select Committee on Medical Ethics defines euthanasia as “a deliberate intervention undertaken with the express intention of ending a life to relieve intractable suffering”. Yet in the Netherlands and Belgium it is defined slightly differently as “termination of life by a doctor at the request of the patient”. It doesn’t necessarily have to involve the relief of suffering, which is an important distinction.

The medical understanding of suffering can be hard to pin down. Does psychological suffering count, and how would that be measured? Perhaps the Dutch and Belgians have simplified the definition for that reason.

A historic case of euthanasia in the UK happened in 1936 when King George V was given a fatal dose of morphine and cocaine to hasten his demise from cardio-respiratory failure. This wasn’t made public until 50 years later. But it suggests that euthanasia might not have been so rare in Britain’s past.

Questions about euthanasia will come up more as the population ages. The debate centres on four issues: the right of people to choose their fate; that helping someone to die is better than leaving them to suffer; that the ethical difference between the commonly practised “pulling of the plug” and active euthanasia is not substantive; and that permitting euthanasia will not necessarily lead to unacceptable consequences. This is the case in the Netherlands and Belgium.

Professor Luke O'Neill's father, Kevin (Photo: Luke O'Neill)
Professor Luke O’Neill’s father, Kevin

On consent, perhaps the person is not able to make the decision – determining competence is not straightforward. Perhaps they feels that they are a burden on medical services or on their family. How do we know unscrupulous friends or relatives aren’t pressuring them? Do hospital personnel have an economic incentive to encourage consent?

There seems to be a growing acceptance of euthanasia in the UK. In a 2019 survey of 2,500 people, more than 90 per cent believed that assisted euthanasia should be legalised for those suffering from a terminal illness. Eighty-eight per cent believed that it was acceptable for people living with dementia, provided that they consented before losing their mental capacity.

In another survey, 52 per cent would feel more positive towards their MP if they supported assisted dying, compared to 6 per cent who would feel more negative.

So what concerns people, apart from religious beliefs?

Guidelines and safeguards are important. Physicians and counsellors are all involved in assessing people requesting euthanasia in countries where euthanasia is practised. In the US, Canada and Luxembourg, the person must be over 18. In the Netherlands, the age is 12, while in Belgium there is no age limit as long as the person has the capacity for discernment.

In the US, there is no need for unbearable pain or any symptoms. In the Netherlands, Belgium and Luxembourg, patients must have “unbearable physical or mental suffering” with no likelihood of improvement, although the person doesn’t have to be terminally ill.

There is a danger that people with severe long-standing depression might want to have their life ended if they are terminally ill. This might be difficult to evaluate, as many with a terminal illness may also be clinically depressed.

In the US, assisted suicide must involve a 15-day period between two oral requests, and a 48-hour waiting period after a final written request. In Canada it’s 10 days and in Belgium it’s one month. The Netherlands and Luxembourg do not have any waiting period.

Across all places where it is legal, around 75 per cent of people who undergo assisted suicide are suffering from terminal cancer. The next-highest condition on the list is motor neurone disease, at 10–15 per cent. Pain is not that common as a motivating factor, with issues such as loss of autonomy and dignity being more important.

The bottom line is that euthanasia, when properly regulated, can give us hope of a better quality of death. We must also strive for scientific advances in bringing better treatments or palliative care for those who suffer.

When I think about the rights and wrongs of euthanasia, I think about Christian de Duve, a famous Belgian biochemist who won the Nobel Prize in 1974 for the discovery of the lysosome. This is the garbage disposal system for cells: it destroys parts that are old or worn out and can digest a cell whole when it becomes old or damaged. Lysosomes are a bit like a euthanasia machine for the cell.

Christian died by euthanasia in Belgium at the age of 95, suffering from terminal cancer. De Duve wanted to make the decision while he still could and not to be a burden on his family. Christian spent the last month of his life writing to friends and colleagues to tell them of his decision. In an interview published after his death, he said he intended to put off his death until his four children could be with him. He was at peace with his decision, saying, “It would be an exaggeration to say I’m not afraid of death, but I’m not afraid of what comes after, because I’m not a believer.”

The second person on my mind when I think of this topic is my father. During the winter of 1995–6, Dad suffered several bouts of pneumonia, almost dying on one occasion. In January of 1996 his GP asked to see me. He suggested that perhaps he wouldn’t prescribe another course of antibiotics and would see if my Dad could fight the latest bout on his own. I knew what he was saying by the way he looked at me.

My dad died peacefully of pneumonia (or ‘the old man’s friend’ as he used to call it) in his sleep on 20 February 1996, with me sitting beside his bed, holding his hand. Not a bad way to go, Dad.

Complete Article HERE!

My wife is grieving for her mum and feels guilty about having sex

“I don’t want to be disrespectful of her grief, but I’m struggling.”

By Suzi Godson

My wife recently lost her mother, to whom she was very close. Understandably, it has really affected her in many ways, one of which is that she feels guilty having sex. She says that’s because she’s enjoying herself, and feels that she shouldn’t be. I don’t want to be disrespectful of her grief, but I’m struggling. What would you advise?

It is difficult to communicate the pain of losing a parent. Whatever the relationship with the parent was like, it is a seismic event for children of every age. Death can create feelings of existential loss that can take a long time to recover from.

You don’t say whether your wife’s mother’s death was sudden, but even when death is expected, it still comes as a shock. Grief must be able to happen at its own pace. Sometimes a grieving person doesn’t have any energy or desire for sex, and they are less motivated to have it because they don’t get the same physiological rewards from the experience.

If your wife is struggling, missing her mum, feeling depressed, it is not surprising that she does not feel very sexual. Grief comes and goes in waves, and even when people appear outwardly to be functioning well and carrying on with life, deep down they may still be suffering. When feeling this way, it can be difficult to surrender to the pleasure that comes with sex. The fact that it may feel as though she is depriving you of intimacy will not be lost on her either, and that may be exacerbating her feelings of guilt.

That your wife lost her mother is also important because research suggests that the death of a mother tends to have a much more profound emotional impact than the death of a father.

In 2006 Dr Elizabeth Lawrence at the University of Nevada explored Gender Differences in Grief Reactions following the Death of a Parent and found a relationship between avoidant coping styles, depression and grief in bereaved women (but not in men). However, when the gender of the deceased parent was examined, the death of a mother – but not a father – was related to increased levels of grief and psychological distress in males and females.

The grief that people experience after bereavement can be very isolating and lonely, and it may seem to you that being intimate might help her to feel less so. Indeed, when people are very sad, intimacy (physical and emotional) can be a hugely important part of the healing process. However, you need to be patient about sex.

The best – in fact the only – thing that you should be doing right now is trying to support your wife emotionally. The worst thing you could do for her, and for your relationship, would be to put pressure on her or give her a deadline to “get over it”. The emphasis needs to be on showing empathy and understanding, not satisfying your sexual needs. It is important to reassure her that you are there for her and that you are comfortable to wait as long as it takes.

If you had a good sex life before, it will come around again in time. But what your wife may need now is hugs, not orgasms. Prioritise her needs, and you will probably discover that kindness and empathy turn out to be a much more effective form of foreplay. Anyone who has felt incredibly sad knows that when a sexual partner is very caring, the non-sexual touch that is such a big part of being supported through a period of intense grief can end up leading to physical intimacy. It is a very different, gentler sexual experience, but it can be a hugely important part of the healing process.

Complete Article HERE!