Month: January 2022

Posted on

With rising covid cases, young people should consider advance-care planning

By Netana Markovitz

When Jordana Fremed, 26, got engaged, she didn’t think that one of the first serious topics the couple would discuss would be death and dying. But soon after, her fiance’s mother was diagnosed with amyotrophic lateral sclerosis, prompting difficult discussions to plan his mother’s end-of-life care.

Eventually, the couple started talking about wishes for their medical care should they be sick or injured and unable to communicate.

The experience “definitely got us thinking about those questions in relation to what we might want for ourselves,” said Fremed, of Teaneck, N.J.

Medical experts such as Rebecca Sudore, palliative medicine physician and geriatrician at the University of California at San Francisco, say that faced with these numbers, more young people should consider advance-care planning — a process that helps people think through medical decision-making should they be unable to communicate themselves.

“You know the old saying, ‘I could get hit by a bus tomorrow?’ And actually you could,” Sudore said. “And covid has shown us, too, that things are unpredictable. For people in their 20s or 30s who don’t have a serious illness, it could be helpful to think, ‘Well, if I did get hit by a bus tomorrow, who would speak up for me?’ ”

Sudore said she thinks that advance-care planning is an important way for people to participate in their own medical care. “People, particularly in their 20s, can think about advance-care planning as a way to prepare for medical decision-making and really to ensure that people have a voice in their health care, both now and in the future,” she said.

Advance-care planning is an umbrella term that may include completing advance directives — documents that provide written instructions for loved ones and a medical team. They may include specific instructions about which medical interventions doctors can perform — or withhold — such as CPR, mechanical ventilation or artificial nutrition.

Directives can also include broader descriptions of what a person considers a good quality of life, such as the ability to run or spend time with family.

These descriptions can help doctors imagine what a patient would want if they could communicate themselves and determine what medical interventions to offer.

Finally, advance directives often designate an individual to make medical decisions on a person’s behalf, should that person become incapacitated.

“It’s important for every person to think about this topic because unexpected and tragic things happen every day,” said Laura Taylor, a palliative care physician at the University of Michigan. “The pandemic has taught us is that even completely healthy adults can develop serious or life-threatening illness from covid-19, especially with the spread of more virulent variants like delta. And some of those people will require a surrogate decision-maker.”

While less likely to die than older adults, Americans in their 20s and 30s do face risks. The three leading causes of death in adults ages 25 to 34 in 2019 were unintentional injury, suicide and homicide, according to data from the Centers for Disease Control and Prevention. As of Jan. 19, over 5,000 adults between the ages of 18 and 29 in the United States have died of covid-19 since the start of the pandemic, according to provisional data from the CDC. Three hundred per 100,000 adults in this age group have been hospitalized.

In advance-care planning, young adults should first consider who they would want to make decisions on their behalf should they be unable to do so. That person is called a surrogate decision-maker or health-care proxy.

Experts agree that young, healthy adults should worry less about the nuances of medical decision-making, such as whether they would want to be intubated, and instead focus on designating a surrogate decision-maker.

“I think the majority of healthy young adults probably would default to receiving all aggressive, life-prolonging interventions that were offered to them if they were to become seriously ill, so it’s less important for young adults to have a detailed sense of their preferences and wishes,” Taylor said. “For young adults, it’s most important to identify the best surrogate decision-maker who understands that person well and can advocate for them.”

Legally, it might not be who they expect.

“People might assume ‘I want my roommate or my partner to make these decisions for me,’ ” Sudore said, “but it could be some estranged family member because that person is the next of kin.”

“I’m thinking about a young unmarried person who may not have a strong or trusted relationship with their parents, who may not want their parents to be their surrogate decision-makers, but they become their decision-makers by legal default,” Taylor said. “It’s really important for that person to decide who they would want to be assisting in medical decision-making for them if they were unable to.”

After choosing a surrogate, it is important to discuss health wishes together to ensure that the surrogate is comfortable making those decisions. Sudore recommended talking to the person about “what’s important in your life, and for your quality of life, and for your health care, so that this trusted person is really prepared to advocate for you if ever they needed to.”

Sudore is the founder and director of PREPARE for Your Care, an interactive site on advance-care planning. It yields a prepopulated advance directive for a specific location, as the process can vary by state. The documents can be updated at any point, should someone’s wishes or circumstances change.

“We have these easy-to-read advance directives,” Sudore said. “They focus on things like value, goals, what brings quality to somebody’s life, which is probably more important to someone in their 20s than ‘Do you want CPR or mechanical ventilation?’ ”

Olivia Duffield, 24, a medical student at Temple University in Philadelphia, first heard about advance-care planning during the terminal illness of a family member when she was a child. After learning more in a bioethics course, she broached the topic of her own wishes to her parents.

“For me, I think about what would happen if I were to get into a car accident or have a really sudden unexpected event that would cause me to potentially be brain dead or to be intubated in the hospital,” Duffield said.

Sudore said advance-care planning should be normalized for young people.

“When I think about it, it’s a kindness to ourselves in the sense that it gives us empowerment to make sure that our voice is heard if there’s a time that we could not speak for ourselves,” she said. “And it’s a kindness to our loved ones by giving them a little bit of a heads up.”

Fremed agrees: “You kind of always think that you have until tomorrow to do it, but things can happen in a moment. Having your other person know what your wishes are and what you want is just a very smart and healthy thing to do.”

Complete Article ↪HERE↩!

Posted on

Hard Conversations About End Of Life Wishes

— Should Young Adults Be Included?

By Carolyn Rosenblatt

Talking about one’s end of life wishes is typically uncomfortable for most. We think of the subject as one for our aging parents to have with us when they are “old”. We don’t usually think it is a necessary subject for younger adults to know about. The truth is, many younger adults are already caregivers and they must deal with these issues.

A real life example is that of Anna, a bright and ambitious teenager when her father had to retire from work on disability. Three years later, he passed away. Anna was an only child, living with her mom. The last thing anyone expected was for her mother to have a health issue.

Anna’s mother, Linda had already retired from teaching at a university. She had a pension and some income from rental real estate. She was working part time in the field of education. At only age 59, Linda began to show signs of memory loss. She was diagnosed with early onset dementia and had to stop working. Anna and Linda lived on Linda’s income. Linda’s dementia progressed. At age 21, just graduating from college and starting her career, Anna became the agent and power of attorney for her mother. Eventually Anna had to sell the family home to pay for her mother’s care. Over time, Linda became a behavior problem and Anna had to place her in a care home. Eventually Anna had to sell off her mother’s invested assets to pay for Linda’s increasing care needs. When the money ran out, Linda qualified for Medicaid but then the choices of care for her were extremely limited. Anna found a low cost board-and-care home for Linda two hours away. It took Anna half a day just to make a visit.

Anna was faced with every decision about her mother all on her own. She got advice from time to time at AgingParents.com but it was a huge burden to manage all this while getting her first jobs and establishing her own career. When end of life decisions had to be made Anna did her best to honor what she thought her mom would want. Linda had not ever talked about her end of life wishes with her young daughter. It was a heavy burden on Anna. When the doctors asked her what she wanted to do at decision time for Linda, she was in tears. She guessed, without being sure and it was emotionally wrenching for her.

The Takeaways

None of us are guaranteed a long retirement with our health intact. None of us need let our family members down by failure to discuss what we want in our last days. The struggle to figure out all the things Anna had to do for her mother was an extremely stressful burden. We owe it to our offspring, or others who would have responsibility to assist us in declining health, to be clear about what we want. We use Advance Healthcare Directives, also called Healthcare Proxies or Power of Attorney for Healthcare to give written instructions to our loved ones. That makes it much easier on them when the time comes. When Linda could no longer say what she wanted, due to Alzheimer’s disease, Anna had to try to imagine what Linda would want. The process was traumatic. She did well regardless, and went on years later to have a family of her own. Hard as it is, she will not repeat her mother’s lack of discussion on this important topic with her own child.

If there is one thing to take from this true story, some of which I witnessed personally, it is that any young adult deserves to know the wishes of an aging parent or any parent with a health issue. Linda could have done that upon becoming widowed. There is a free, downloadable version of an Advanced Healthcare Directive available on the internet, from your doctor’s office or your nearest hospital. If any part of it is unclear, a conversation about it with a medical professional can help.

Above all, fill it out and sign it as the document requires, with either a notary or witnesses. With this simple step, you are saving your younger loved ones from conflicts and distress about what to do near the end of your life. And equally as important, take the document out and show it to every adult in your family who will be appointed to carry out your wishes. Make it easier on them at a possibly difficult time. It’s the responsible and caring thing to do. If you need some help, free guides are available at The Conversation Project to get you started.

Complete Article ↪HERE↩!

Posted on

When patients don’t want to be saved

— Navigating the right to die

By Jules Murtha

  • Patients have a right to shape their end-of-life care with advance directives and other palliative care options.
  • Clinicians can better serve patients of different faiths by approaching care with cultural competency.
  • When ethical dilemmas regarding palliative care arise, clinicians can return to the basic ethical principles: autonomy, beneficence, nonmaleficence, fidelity, and justice.

The relationship between morality and death is a historically significant one. Modern death in America often entails care provided by strangers in an institution flooded with machinery, far from the comfort of one’s family and home. Many physicians and scholars deem this a poor way to die.

Now, some patients nearing the end of their lives have an alternative to prolonged suffering in a hospital: Medical-assisted death. The moral logic supporting a patient’s right to terminate their life by means of lethal medication, either through self-ingestion or with a doctor’s help, is based on harm reduction. Legal, ethical, and professional controversies related to this practice are still surfacing.

The process of terminating care

Death is inevitable. The degree to which one suffers, however, can be modified by choosing appropriate end-of-life care. According to a 2021 article published by SAGE Open Medicine, mitigating suffering, optimizing quality of life, and providing comfort in death are the goals of palliative care.

What is an advance directive?

When a patient is no longer capable of communicating their desire to terminate treatments, advance directives are useful. An advance directive is a legal document specifying the kind of care a patient wants to receive, should they lose the ability to communicate due to a serious injury or neurodegenerative disease. Patients who complete them must be at least 18 years old.

Advance directives may include the following:

  • Living will: A legal document that describes medical or life-sustaining treatments patients may want if they become permanently unconscious or terminally ill. Writing a living will gives patients the power to make decisions for themselves when unforeseen circumstances arise.
  • Do not resuscitate order (DNR): The formal request that hospital staff do not perform CPR on an individual if their heart or breathing stops. DNRs do not have to be a part of a living will. They are accepted in all states.
  • Durable power of attorney for healthcare (DPA): Legal in most states, a DPA specifies whom is held responsible for a patient’s healthcare decisions if the patient is unable to make them on their own.
  • Physician orders for life-sustaining treatment (POLST): Designed for patients with serious illnesses, physicians complete POLSTs to ensure patients receive their desired care.

Advance directives may be especially helpful for patients who endure immense suffering. A patient with terminal cancer, for example, may document their request that hospital staff forgo  a respirator if they stop breathing. This gives the patient power over their own healthcare—which includes the right to die—and mitigates suffering by offering peace of mind.

Cultural competency and self-determination

Another factor for clinicians to consider when providing end-of-life care is each patient’s cultural and religious beliefs. When clinicians establish cultural competence—the ability to implement care with a patient’s cultural, religious, and social needs in mind—the quality of care improves.

The importance of cultural competence in healthcare extends to patients’ mental health and daily life. According to a 2021 article published by StatPearls, health-related anxiety diminishes in patients when they can turn to their faith.

Religion and spirituality inform some patients’ healthcare decisions regarding diet, medicine, modesty, and gender of their health providers. They can also inform practices surrounding death. For example, several religions strictly prohibit euthanasia, including Mormonism, Hinduism, Islam, Jehovah’s Witnesses, and others.

The influence of religion

On the other hand, physicians may legally refuse to provide certain types of standardized care that aren’t conducive to their own religious beliefs. This is often the case for Catholic doctors who refuse to perform abortions or sterilizations, as written in an article published by the American Medical Association Journal of Medical Ethics.

Doctors who choose not to provide emergency treatments based on conscience laws may be subject to tort liability, giving patients who are harmed by medical inaction the opportunity to sue for medical malpractice.

To avoid this situation altogether, physicians can abide by transparency requirements and protect patients from medical refusals by informing them about the practice. Patients may then seek appropriate care elsewhere, if possible.

Increased cultural competency and better palliative care options for patients of specific faiths is dependent on education. Patient care improves when physicians acquire cultural competence through proper training. Healthcare institutions fare better overall when their staff, including non-clinicians, are prepared to notify patients about medical refusals and a patient’s right to self-determination.

How medical ethics can aid physicians in palliative care

When doctors face ethical dilemmas regarding palliative care or a patient’s right to die, they can look to the universal ethical principles for guidance. According to SAGE Open Medicine, these principles include autonomy, beneficence, nonmaleficence, fidelity, and justice.

Medical ethics hinge on a healthcare professional’s ability to respect the autonomy of their patients. Autonomy, which is a patient’s right to self-determination, can be protected by advance directives before a patient loses the ability to create one. Patients have the right to terminate or refuse treatment altogether, which physicians should support out of respect for patients’ autonomy.

Reducing harm

When a patient no longer has the ability to create an advance directive, doctors must pursue treatment plans most beneficial to the patient. Physicians in this position can practice nonmaleficence by choosing care plans that cause the least possible amount of harm.

Justice and fidelity are served by doctors who are honest with their patients about prognoses and care options, including a patient’s right to terminate treatments. Truth-telling, as well as fair distribution and knowledge of health resources, is necessary in order to effectively respect patients’ self-determination.

While “dying badly” is still the norm in most of the US, there are 10 jurisdictions in which patients can pursue medical-assisted deaths. According to the Yale Journal of Biology and Medicine, Oregon, Montana, New Jersey, and Colorado are just a few.

What this means for you

Where legal, physicians can inform patients of their right to self-determination, granting them peace of mind and control in their final days. Regardless of your own spiritual or religious beliefs, acquiring cultural competence will improve the care physicians provide to patients. Finally, when end-of-life care presents physicians with ethical challenges, they can take a cue from the five ethical principles guiding healthcare professionals: autonomy, beneficence, nonmaleficence, fidelity, and justice.

Sources

  1. Akdeniz M, Yardımcı B, Kavukcu E. Ethical considerations at the end-of-life care. SAGE Open Medicine. 2021;9:205031212110009.
  2. Campbell CS. Mortal responsibilities: bioethics and medical-assisted dying. Yale J Biol Med. 2019;92(4):733-739.
  3. Familydoctor.org editorial. Advance Directives and Do Not Resuscitate Orders. Familydoctor.org. 2021.
  4. Kogan R, Kraschel KL, Haupt CE. Which legal approaches help limit harms to patients from clinicians’ conscience-based refusals? AMA Journal of Ethics. 2020;22(3):209-216.
  5. Swihart DL, Yarrarapu SNS, Martin RL. Cultural religious competence in clinical practice. In: StatPearls. StatPearls Publishing; 2022.

Complete Article ↪HERE↩!

Posted on

The pandemic changed death rituals and left grieving families without a sense of closure

By

The unexpected death of a friend and colleague to COVID-19 in January 2021 led me to start researching how American death rituals were transforming during the pandemic. My friend was Hindu, and while watching his funeral on Zoom, I witnessed the significant transformations that had to be made to the traditional rituals to accommodate COVID-19 safety guidelines.

In the spring and summer of 2021, I conducted over 70 hours of oral history interviews with people involved in the medical and funerary professions, as well as grieving families and those who worked closely with them, including grief counselors, hospice workers and even spirit mediums.

As a historian of religion interested in how different cultures make sense of death, I noticed what appeared to be a momentous cultural shift happening in America in terms of death rituals as over 850,000 Americans died from COVID-19. During this period, funerary customs dramatically shifted and, in many cases, failed to bring any comfort to grieving friends and families.

What changed in funerary rituals

In my conversations, funerary professionals described the initial chaos as funeral size had to be dramatically curtailed, sometimes with only one to two hours’ notice. Eventually, many began to innovate with new technologies that allowed them to hold virtual funerals.

Richard Davis of the Cook-Walden Funeral Home in Pflugerville, Texas, described how early in the pandemic he utilized radio technology for grieving families who could be in their cars in the parking lot, tune the radio to a specific station and listen to the person giving the eulogy inside the funeral home.

Some funerary directors partnered with wedding videographers whose business was suddenly upended because most weddings were canceled or delayed. These videographers found that the high-quality equipment used to produce wedding videos could as easily be put to use broadcasting a Zoom funeral.

I also spoke with three spirit mediums who all described a marked increase in clients seeking postlife words from loved ones who died on ventilators. They described how anguished families sought to know that their loved one had not died alone and did not blame them for their death. One medium in particular also noted that the pandemic saw an increase in family members seeking to connect with those who had died of drug overdoses brought on by the stress of the pandemic.

The end-of-life work of religious leaders was transformed as well: Catholic and Episcopal last rites were performed via FaceTime, sometimes with consecrated oil being carefully administered by a Q-tip.

The Jewish tradition of sitting with a body before burial – usually performed by volunteers in shifts at the funeral home – became an at-home experience. Although the volunteers, called shomer or shomeret in Hebrew, could not sit next to the body as usual, they worked on the honor system to ensure that someone was always praying and keeping the deceased in their thoughts, even while far away.

Muslim leaders described working with local health agencies to obtain Personal Protective Equipment (PPE) and specialized training for those performing the full-body washing of a corpse known as ghusl in Arabic.

Virtual commemorations

These adaptations reflect a long history of transformations for the American funeral.

In the 17th and 18th centuries, most Americans generally prepared the body themselves and hosted the funeral at home. However, by the 19th century, more Americans were dying in hospitals as a result of the availability of medical care and because the corpse was believed to be carrying disease. This spurred the development of the funeral home. Individual funeral homes often personalize their offerings to the needs of local cultural or religious communities.

Funeral homes became most popular after embalming – a form of preservation performed by mortuary specialists – became the norm after the Civil War. The war spurred a crisis to preserve soldiers’ bodies while they made the long trip home, and embalmers would sometimes follow the military troops to accept payment in advance for the procedure.

Today, the funeral industry has grown to a whopping US$20 billion, and embalming remains the predominant treatment for the body after death.

With the rise of the internet, funerals are once more undergoing rapid transformations. Scholar of death and dying Candi Cann has shown how the internet gives rise to new forms of social remembrance after death. These can include mourners going to Facebook or Instagram pages on the anniversary of the death and leaving a message about how much they miss the deceased. Online marketplaces allow for the purchase of individualized mourning paraphernalia like T-shirts or bumper stickers, and public memorials at the site of death.

Photographs of people stacked one behind another in a park.
People tried to memorialize their loved one in different ways. Images of COVID-19 victims from Detroit are displayed in a drive-by memorial at Belle Isle State Park. Aaron J. Thornton/Getty Images

Such tools thrived during the pandemic. During my research, several individuals who lost loved ones explained creating memorial items, including stickers and face masks commemorating a lost loved one, as a way to encourage others to wear masks. Virtual online communities of COVID-19 mourners adopted the yellow heart as a public expression of loss of a loved one to the pandemic in the U.S. and Europe.

Unprocessed grief

Funerals and other rituals surrounding death are important to begin the grieving process. Research has found that performing rituals has a major role in alleviating grief through increasing feelings of control and transitioning mourners to accepting their loss. Funerals can provide important structures for families to say goodbye that have been correlated with better grief outcomes.

J.Z. Smith, one of the most influential theorists of religion in recent years, said that “ritual relies for its power on the fact that it is concerned with quite ordinary activities placed within an extraordinary setting.” In other words, ritual takes elements from the ordinary world – words, gestures, symbols, etc. – and imbues them with extraordinary meaning.

We might cry or wear black clothing every day for any number of reasons, but in funeral rituals these activities have special significance and bring a sense of closure. It is this repurposing of ordinary things that makes rituals so effective.

Psychological studies too have shown that the greater the difference between what happens in the ritual and “normal” life, the more effective it is for individuals.

But in my conversations with those who lost loved ones to COVID-19, it became apparent that for many, the transformations in funerals and rituals of mourning failed to help them in dealing with their grief. As one individual explained to me, “I knew my grandmother would pass away sometime, but I always imagined I would be there; I never imagined I would be watching it virtually on Facebook. It felt like a parody of a funeral.”

Another interviewee explained how the isolation necessary in the pandemic era fundamentally undermined the comfort these rituals could provide: “Because my family has been so terrified of COVID, we have not been able to gather together to process my mother’s death. That has been really hard for me culturally – especially in Indigenous families, you grieve together.”

Reverend Richard R. Andre, C.S.P. of St. Austin Catholic Parish in Austin, Texas, echoed these thoughts as he described assisting those losing loved ones in his own spiritual community: “The funeral helps you to start a process of closure. But without the funerals they envisioned, people are just getting stuck and are unable to grieve.”

The COVID-19 pandemic has forced us to consider how rituals can lose their extraordinary power when our sense of “normal” is shattered and remains shattered for years. As religion theorist J.Z. Smith noted, rituals work by framing the ordinary as extraordinary. But if nothing feels normal, then nothing can feel extraordinary either.

Complete Article ↪HERE↩!

Posted on

How to navigate dating after the death of a partner

People can sometimes feel guilty for moving on, but they shouldn’t

By

Losing a partner is one of the hardest things a person can ever go through.

While it wanes, the grief never leaves. As humans, we merely learn to live with it.

And feelings associated with loss can be complex – particularly when it comes to the thought of potentially dating again, or becoming romantically involved with someone new.

While, understandably, this may not be on a bereaved partner’s mind for some time, if (or when) it does happen, it can be difficult.

There are many reasons for this, some more obvious than others.

‘Many people who’ve lost a partner find it difficult to consider meeting someone new because they may tell themselves that it would be as if they were trying to replace the person they’ve lost,’ explains relationship expert Rhian Kivits.

‘They may feel like they’re being disloyal or that moving on is fickle. 

‘Some even fear the judgment of friends and family and the idea of meeting someone new is shrouded in shame.

‘Others sometimes worry that potential partners will be put off by the fact that they’ve been bereaved, as it can feel like a heavy burden to carry into a new relationship.’

There are lots of things to take into consideration but the most important element is to be kind to yourself and move at a pace that feels comfortable to you.

Experts have shared some other things to keep in mind.

How to deal with feelings of guilt and anxiety

‘Remember, living a meaningful and full life is the best antidote to death’

‘Re-establishing a romantic or a sexual dimension to one’s life can feel disloyal to the person you’ve lost,’ says senior therapist Sally Baker.

‘Plus, developing a new physical relationship can provoke anxiety in someone who has been monogamous for a long period of time.’

Sally suggests that all of these fears and anxieties are natural – but that they might feel greater than necessary if a bereaved person is pushing themselves to get back out there intimately, before they are emotionally ready.

So, it’s important to move at your own pace.

However, feelings associated with guilt are often complicated and it’s not always connected to starting a new relationship.

‘People can sometimes even feel guilty for surviving when their loved one has died,’ Sally explains. ‘I would remind them that the person who they lost wouldn’t want them to just survive, but to thrive.’

Dr Venetia Leonidaki, Doctify-reviewed consultant psychologist and founder of Spiral Psychology, agrees.

She says: ‘Even though your partner died, you are still alive. Living a meaningful and full life is the best antidote to death.’

Dr Venetia echoes Sally and suggests considering what you think your partner would want for you, and how you would feel if it was the other way round.

‘If things had turned out differently and you were the first to die out of the two of you, how would you feel about your partner starting a new relationship?’ she adds.

‘Your love for your partner never dies. You may always carry your partner and your shared memories within you.

‘However, this doesn’t mean that there will be no space in your heart for someone new.’

Try to not let feelings of guilt consume you, and remember that this doesn’t mean you are replacing your partner.

‘It helps to acknowledge that you’re not looking to replace your loved one, and to remember that the new people you’ll meet are unique, so they’ll bring different qualities and experiences into your life,’ adds Rhian.

‘You deserve to enjoy companionship, affection, love and sex and you still have a precious life to live.’

Know there’s no timeline

Every person is individual when it comes to their readiness to date after bereavement.

‘Rather than impose a timescale on it, I prefer to encourage the person to understand their motivations for dating,’ says Rhian.

When someone has found peace and acceptance around their loss and feel ready to begin rebuilding their lives, this is when someone is likely to be ready.

‘If they’re using dating to avoid or alleviate their grief, or they have the idea that dating will help them erase the past, they’re probably not quite ready yet,’ she continues.

While there is no ‘right’ or ‘wrong’ time, Sally suggests that, often, the most acute pain of a bereavement fades to a more manageable level between a year and two years.

‘However,’ she says, ‘there is no carved in stone timeline and the circumstances of their loss and the quality of their relationship means feelings of sadness can be exacerbated or eased.’

She adds that it’s completely acceptable not to feel ready for a long time.

However, you may have to learn how to navigate other people’s expectations and be very clear what’s up for dialogue or discussion.

Don’t worry about what other people think

Some people may feel that there is a ‘stigma’ attached to moving on too quickly with rebuilding your life.

However, this fear of other people’s judgments could prevent you from getting back into considering dating, stresses Dr Venetia.

This is why it’s important not to place emphasis on what other people have to say, and listen to your own emotions.

Family and friends will likely have had a relationship with your partner as well, and this can impact their opinion on things.

‘There will always be people who believe the bereaved should stay in mourning and never embrace a new life,’ says Sally.

‘However, a close brush with mortality that losing a loved one can bring often spurs people on to live their life as fully as possible – or at least to believe it’s their time to make decisions that suit them best.’

Sometimes, it can even go the other way, with people who care about you usually being too keen to find solutions that they think will make you feel less sad.

‘Suggesting or even pushing you towards a new relationship may be how they express their concern towards you,’ says Dr Venetia.

‘They think that this is what will make you feel better. However, you will know best when (and if) you are ready to meet a new person. Take your time, listen to your heart, and don’t allow anyone to rush you through.’

Ultimately, experts say it’s not up to anyone but the individual to decide whether it’s time to start dating.

Rhian adds: ‘If other people are judgemental, it’s possibly because they haven’t fully processed the bereavement themselves or have a fixed perspective based on misplaced morals.’

However, she stresses that most friends and family will want the person to be happy, and understand that the desire for company, love, affection and sex is only human.

Fill your life with other things

Find other things that bring you joy

While moving on might be the right thing for some people, it’s completely acceptable if you feel that you don’t want another partner in your life.

‘After their partner’s loss, many people find ways to live a fulfilling life which do not involve a new relationship,’ says Dr Venetia.

She suggests that finding other ways to fill your life with happiness is a good tactic.

‘Spending more time with friends or family, focusing on work, discovering new hobbies, reconnecting with your faith or spirituality, travelling, helping others or finding ways to honour your partner’s memory,’ she continues.

‘All of these things can all give meaning to your life and bring joy.’

Go at your own pace

For those who do decide to put themselves back out there after such a loss, it can be scary – however, you are not alone.

‘Take your time and go at your pace,’ suggests Sally.

‘Try to resist pressure from others to meet their expectations. You’ve suffered a huge loss and earned the right to put your own needs first.’

It’s normal for things to feel a bit strange at first and there’s never any need to rush or make commitments.

Rhian adds: ‘Be clear about your boundaries and what you feel able to offer a potential partner.

‘And know that if it doesn’t work out, or if feels like it’s a mistake, you can pause and return to dating again when you feel more aligned.’

Consider asking for help

While it’s completely understandable, and acceptable, to not want to move on, there might be a time to think about asking for professional help.

Rhian advises the following: ‘If you are concerned that you’re stuck in your grieving process, if you suspect you’ve developed anxiety or depression or worry that you’ve become too fearful to date, it’s worth talking through your concerns with a therapist.’

Whatever happens, never be afraid to ask for help if you need it, don’t worry what other people think and take steps to do whatever feels right for you.

If you’re struggling and think you need help from someone more removed from the situation, you could also contact a support organisation such as Cruse Bereavement Care.

Complete Article ↪HERE↩!

Posted on

I’m a rabbi and I helped my father end his life

By Rabbi Rachel Timoner

“Promise me you will help me die.”

My father was 92 years old. He had congestive heart failure and COPD. He was living on oxygen and a dozen medications that had kept him alive since a debilitating stroke paralyzed him forty years ago. Last year, when his doctors told him that he was dying in a matter of weeks, or months, he urgently, desperately needed to end his life on his own terms.

My phone would ring in my Brooklyn apartment.

“Dad?”

“You have to help me die today, Rachel. I need to die today, please.”

“I can’t help you die today, Dad.”

“Rachel, please, you have to help me.”

This is how it went, day after day, sometimes several times a day, until my brother realized that in California, where they live, it was legal for my father to choose to end his own life.

And that is how I found myself at my father’s bedside in Los Angeles, supporting him as he took his own life, as his daughter and as his rabbi.

Judaism holds life sacred. In Genesis, when creating humans, G-d sees that it is very good. G-d creates us in G-d’s own image and breathes life into human beings, giving human life supreme value. The Mishnah teaches that saving one life is like saving an entire world. Pikuach nefesh (saving a life) supersedes all other mitzvot, except those forbidding murder, adultery, and idolatry. This love of life is the foundation of Jewish ethics and has led our tradition to stand firmly against any action that would lead to death.

Thus we read in the “Comprehensive Guide to Medical Halakha,” published in 1990 by Abraham S. Abraham:

“One may not hasten a death, even that of a patient who is suffering greatly and for whom there is no hope of a cure, even if the patient asks that this be done. To shorten the life of a person, even a life of agony and suffering, is forbidden.”

And in “Modern Medicine and Jewish Ethics” by Fred Rosner in 1991:

“Any positive act designed to hasten the death of the patient is equated with murder in Jewish law …. only the Creator, who bestows the gift of life, may relieve man of that life, even when it has become a burden rather than a blessing.”

I am a rabbi. I know well Judaism’s ban on euthanasia. But when I understood that my father would take his own life, I knew without a doubt that I would be by his side. He had soldiered on in this life for 92 years, uncomplaining, to be there for us and for his grandchildren. Now he wanted to leave the world, and all I could do was honor his wishes.

As this became my father’s story, I began to inquire more deeply into our tradition and found voices questioning this consensus in Jewish law. For example, Rabbi Leonard Kravitz argues that the story of the torturous death of Rabbi Hananiah at the hands of the Romans, which is usually read as a proof-text for the ban on euthanasia, can equally be read to make the case that hastening death when death is inevitable is an act of mercy. Rabbi Kravitz argues that Jews who are terminally ill and suffering should be able to choose a mitah yafah, a good death, which Rashi defines as sheyamut maher, that they should die quickly, particularly given that the Talmud prescribes this kind of death for criminals who will be executed by the court. If criminals deserve a good death, a death in which they are spared long, slow agony and suffering, Rabbi Kravitz argues, shouldn’t those who’ve committed no crime be allowed to choose this as well?

I raise this now in this public forum because my sister has made a film about my father’s death called “Last Flight Home,” and her film is premiering at the Sundance Film Festival today. In the film, viewers will see me, acting as a daughter and also a rabbi, loving and supporting my father as he ends his own life. I am aware that this will be upsetting and even offensive to many in the Jewish community. I do not wish to create controversy on this issue, and I would not have chosen to make this film. I would not have chosen for my father’s death to be viewed by the public at all, and I would not have chosen to champion this issue. But I have cared for others who desperately wished for this choice at the end of their lives, and I think it might be time for the Jewish people to reconsider our views on this important matter.

March 3rd will be my father’s first yahrzeit. May his memory forever be a blessing.

Complete Article ↪HERE↩!

Posted on

Which country is the best place to die?

Scientists ranked countries on their end-of-life care. The U.S. fared poorly.

By Ross Pomeroy

Key Takeaways

  • Researchers conducted an international survey to determine what constitutes good end-of-life care and which countries are the best at providing it.
  • They scored 81 countries, most of which earned a grade of “C” or below for their palliative care. The United Kingdom ranked first. The U.S. ranked 43rd.
  • Higher income, universal health coverage, and wide availability of opioids for pain relief were generally associated with better scores.

Death is an inevitable part of life — a mysterious climax that all humans face, evoking wonder and trepidation. That’s why dependable end-of-life care is so vital. While only some of us break bones, develop cancer, or catch an infectious disease, we all die eventually. To depart with dignity in relative comfort shouldn’t be a rare privilege.

Regretfully, new research published in the Journal of Pain and Symptom Management shows that many countries do not offer their citizens a good death.

Eric Finkelstein — a professor of health services at the Duke-NUS Medical School, Singapore, and the Executive Director of the Lien Centre for Palliative Care — led an international team of researchers to conduct a sweeping analysis of countries’ end-of-life (palliative) care. Finkelstein and his colleagues first set out to characterize quality end-of-life care, reviewing 309 scientific articles to determine the factors involved. A few that they identified included:

  • The places where health care providers treated patients were clean, safe, and comfortable.
  • Health care providers controlled pain and discomfort to patient’s desired levels.
  • Health care providers provided appropriate levels and quality of life extending treatments.
  • Costs were not a barrier to a patient getting appropriate care.

The researchers settled on 13 factors in total. They then surveyed 1,250 family caregivers across five different countries who had recently looked after a now-deceased loved one to ascertain the relative importance of each indicator. Here’s how the factors ranked:

Credit: Finkelstein et al. / Journal of Pain and Symptom Management

Finally, the researchers sought out hundreds of experts from 161 countries to rank their respective country’s end-of-life care based on these weighted factors, asking them to “strongly disagree, disagree, neither agree nor disagree, agree, or strongly agree” with whether their country’s healthcare system generally met each palliative need. To be eligible, experts had to be “either 1) a representative of the national in-country hospice-palliative care association or similar national professional association with an established leadership role, 2) a health care provider (physician, nurse) involved in provision of palliative care, or 3) a government employee or academic with knowledge of palliative care in the country.”

At least two experts were required to respond from a specific country for the researchers to consider the nation’s score valid. In all, 81 countries comprising 81% of the world’s population ended up being ranked.

Credit: Finkelstein et al. / Journal of Pain and Symptom Management

The United Kingdom earned the highest score in the study, followed closely by Ireland, Taiwan, Australia, South Korea, and Costa Rica. These were the only countries to earn an “A” grade, scoring 90 or above. Ukraine, Argentina, South Africa, and Lebanon were a few of the 21 countries to merit an “F” grade, scoring 60 or below.

Finkelstein found the results disheartening.

“Many individuals in both the developed and developing world die very badly – not at their place of choice, without dignity, or compassion, with a limited understanding about their illness, after spending down much of their savings, and often with regret about their course of treatment,” he said in a statement.

Higher income, universal health coverage, and wide availability of opioids for pain relief were generally associated with better scores.   

Of note, the United States earned a “C”, ranking 43rd of the 81 countries with a middling score of 71.5. Commenting on why the U.S. ranked so poorly, especially compared to other high-income countries, Finkelstein said that Americans often spend tons of money on excessive, often futile treatments and surgeries aiming to extend life at the dusk of one’s existence — sometimes just for weeks or months — rather than focusing on ensuring quality of life at the end.

A key drawback of the study is that each country’s ranking was determined by an average of only two experts. While the researchers made clear that these experts are quite knowledgeable and respected, it seems hardly fair to rate an entire country’s end-of-life care system based on the opinions of just two individuals, each of whom is undoubtedly biased by their own experiences.

The experts were also asked for their thoughts on what facilitates good end of-life-care in a country. Collectively, they suggested that investment from the national government, patient-centered, integrative care, and universal healthcare with free access to palliative care services contributed greatly.

Complete Article ↪HERE↩!