Why Taking Death Seriously Will Change Your Life

— Reena Lazar and Christa Overnell are working to shift our approaches to end-of-life planning.

Christa Ovenell, left, and Reena Lazar, right, take a selfie in front of people who gathered at one of their workshops at Mountain View Cemetery this year on how to plan for death.

On a balmy April evening, Renna Lazar leaned into the microphone, hushed the murmuring crowd and introduced herself. Then she addressed the topic that attracted roughly 60 people, young and old, to Vancouver’s only operating graveyard. Their death.

“We’re all going to die one day,” Lazar, who is co-founder of Willow End of Life Education & Planning told those assembled at Mountain View Cemetery, “Let’s start thinking about the reality of our mortality.”

In many western cultures, death is a taboo topic that people often avoid discussing — despite the fact that everyone dies. A 2019 survey in the U.K. found that six out of 10 people knew “little or nothing” about what happens at the end of someone’s life.

In Canada, the situation isn’t much better.

A 2016 Ipsos poll reported that just over half of the Canadians they surveyed understood palliative and end-of-life care.

But discussion about death, and how to plan for death, will be more important as Canada’s senior population is expected to skyrocket.

Data from the 2021 census showed that Canadians over 85 were one of the fastest growing age groups in the country. Buoyed by the baby boomer generation, the number of Canadians over the age of 85 will triple in the next 25 years.

That rate has led some to worry about how all of those elders will be cared for in their final stages of life, and whether their families and close ones will be prepared to have difficult conversations about death.

Lazar and co-host Christa Ovenell, founder of Death’s Apprentice, a personal planning and death consultation service, are hoping to shift the conversation around death in the Lower Mainland.

“Some of us might never buy a car, some of us might never get married or have children, but we will all die,” Ovenell said. “People spend more time checking out their cell phone plan than they do thinking about their end-of-life plan.”

The duo has launched a four-part workshop that will focus on a variety of topics — ranging from how to have an environmentally friendly burial to discussing the logistics of medically-assisted deaths — until November.

Following the first workshop, Lazar and Ovenell caught up with The Tyee to discuss why Canadians avoid talking about death. This interview has been edited for length and clarity.

The Tyee: What was the motivation to create this four-part workshop?

Reena Lazar: I’ve been touched by death, like so many people. I was in a scary car accident when I was 16 years old where the car flipped.

Fortunately, everyone was fine, but the first thing I did after the accident was take out a pen and paper and write letters to my three best friends at the time. I told them how much I loved them, what I appreciate about them, what I wished for them. I knew I was alive and well, but you come to appreciate life when you’re faced with death. There’s so much written about people in their dying days having these incredible transformations and having an awakening about what’s important to them.

So the whole premise of Willow is to help people “wake up before their time’s up.”

Christa Ovenell: I’m a Willow educator as well, but I’m also a woman in her late 40s who after being impacted by the work of Willow educational programming, decided to quit a high-paying and prestigious job and go into end-of-life care. I became a licensed funeral director and embalmer with the sole intention of messing with the status quo when it comes to death and end-of-life care. Because I believe we don’t really do death right in our society.

Why are we so reluctant to talk about death?

Lazar: I want to say it’s more of a western thing. It’s not a global problem, there are certain cultures that contemplate death all the time.

Ovenell: Industrialization has had a lot to do with why we in the West, in particular, have become so distanced from death as part of life. We just make the problem go away, call the funeral, take the dead person away.

In Victorian times, we would shield children from the messy realities of birth. But we would pull them in as little helpers when people were dying. As we cared for our dying, even our children would get a cool cloth and help. Whereas now, it’s kind of the opposite. Siblings will be there at a birth, but they are often not allowed to go to funerals.

I’m wondering how, if at all, has the pandemic shifted the conversation and the public’s approach to death?

Ovenell: I think it has been good in some regards, and in others, I have been told flat out it’s been too hard a time. We can’t engage in this conversation right now because everybody’s too distraught. I’ve also been told the exact opposite: “We need this more than ever now,” because people don’t know how to deal with [death].

Lazar: I agree. I don’t think we have the numbers or statistics to say whether this opened up our dialogue more or not, but it’s hard for us to know anecdotally.

It’s a nice segue to what’s going to happen, or what’s happening, with baby boomers. [The pandemic] has almost been like a dress rehearsal. Now we’re going to have people dying of all sorts of different causes, not just COVID-19…. We’re going to have way more deaths than we used to, and because they are boomers, they may want to die differently. For many that might be dying naturally, which means dying at home, being buried in a “green” cemetery, or something else.

You have both been in this space for years. In your professional practices, what gaps have you noticed in your discussions with health-care workers, or funeral directors, that you hope to change in your workshops?

Lazar: One thing that bugs me is that there’s been an effort among public institutions to get people to do their end-of-life planning, or their advanced care planning as it’s called. They have all these forms online you fill out. Where they fall short is they make the assumption that people already know what they want, what’s important and what their values are.

So a lot of people get this free material, they might go to a free presentation, and they get the form and they’re like, “I don’t know how to fill this out because I don’t know what to say.” So that’s where Willow comes in. We’re heart-centered and inquiry-based.

Ovenell: In our strained and taxed health-care system right now, there is so little time for meaningful discussion and understanding. We have all these things that are like “tick this box, which box do you fit into?”

Lazar: I thought you were going to get into this, Christa, but the funeral industry itself. Most funeral homes are owned by like two companies?

Ovenell: In Canada, we have two major companies [Service Corporation International and Arbor Memorial Inc.] that own virtually all of the funeral homes. It’s good for them if people don’t know what is happening until death occurs.

Why is that?

Ovenell: Because then they’re the experts. Then they can say, “here’s what I think you should do.” This is not my analogy, this came from a writer named David Lynch, but he said imagine going into a car dealership, walking in, taking out your wallet and saying, “I need a car.”

What should I get? How much will it cost? There is no other thing that we ever meet in our lives that we would go into with as little preparation as our actual death. That is one thing that we all do.

What do you hope people take away from these sessions?

Ovenell: Life changing shit.

Lazar: I don’t really have to hope because I’ve done enough [sessions in the past] to know what they take away.

They, first of all, are inspired and empowered to start doing some planning and having conversations. To me, the best gift they can do is to start talking about this stuff with people in their circles: their brothers, their sisters, their families, their communities.

Complete Article ↪HERE↩!

May 8, 2023May 8, 2023

Depression, fear and deterioration

— Why some Asian families avoid speaking about death

When Mishelle Tongco’s grandfather was given 30 days to live, her family decided not to tell him.

By Mishelle Tongco

My Filipino-Chinese grandfather taught me many things as I was growing up — from how to make spring rolls to the importance of family.

One of the most important lessons he passed on, was that no good ever comes from lying, no matter the circumstances.

“We must obey the word of the Lord,” he would tell us.

But for the last month of his life, my whole family and I withheld the truth from my grandpa.

In April last year, after more than two years on dialysis, he was given a month to live — and we decided not to tell him.

Lady sitting in front of a grave — Many Asian families believe that hiding information will protect their relatives from emotional harm.

Being born and raised in Australia, I did not understand what was happening — I thought this was something that only happened in my family.

But families withholding information about a life-threatening diagnosis is actually common practice in Asian cultures.

It is believed that speaking openly about death can do more harm than good, bringing bad luck, fear and emotional pain.

Yongxian Luo, a professor of Chinese studies at the University of Melbourne, said Asian families regularly chose to hide the truth about a terminal illness from their loved ones to protect them.

Professor Luo calls them “non-disclosure topics”.

“Certain topics, which are common for people to talk about in Anglo-American culture, are taboos or at least not preferred in discourse,” he said.

“For non-disclosure topics, the major difference is that Asian cultures do not want to talk about negative things.”

Dr Nicola Atkin says some cultures put more emphasis on familial responsibility and less on individual autonomy.

Dr Nicola Atkin, from the Peter MacCallum Cancer Centre in Melbourne, said that in her experience caring for patients and families from Asian cultures, they often put a greater emphasis on the patient as part of a family and community than on individualism.

“Some cultures have far less emphasis on the individual and individual autonomy but more on relational autonomy and a view of the patient in the context of their family, community and culture,” she said.

“This focus from family members on non-disclosure often goes hand in hand with a very strong sense of responsibility and duty to protect and care for their loved ones.”

Professor Luo said this emphasis on family shaped how people in Asian cultures engaged in most social and interpersonal relationships.

“Mutual trust is a top priority,” he said.

“In Hong Kong, a number of successful family businesses don’t hire outsiders because family members are more trustworthy.

“This is something Asian people would bear in mind when they think about social relationships.”

Sometimes these conflicts between Eastern and Western values can happen within families, particularly those in the diaspora.

A still from the film The Farewell showing a family standing and looking at the camera. — The Farewell is about a Chinese family who decides not to tell their grandmother that she is dying of cancer.

Based on her own experience dealing with her grandmother’s cancer diagnosis, US filmmaker Lulu Wang wrote and directed The Farewell, a 2019 drama/comedy that explores the cultural differences in approaches to death.

In the film, the mother of the central character, Billi Wang, relates a saying in China: “When people get cancer, they die. It’s not the cancer that kills them, it’s the fear.”

So when Chinese-born American Billi’s “nai nai” (grandmother) is given a few weeks to live, her family decides not to tell her.

The family struggles with this decision, especially Billi who believes her grandmother has the right to know.

“Isn’t that wrong to lie?” Billi asks her grandmother’s doctor.

“It’s a good lie,” he responds.

In Asia, doctors will generally comply with a family’s wishes when disclosing a diagnosis, using less specific and threatening terms such as “fever” or “sickness”.

Dr Atkin said both the family and patients usually shared the same attitudes when it came to this practice.

“Families have stated that they believe the patient will become depressed, lose all hope or deteriorate more quickly if they know the details of their disease or their prognosis,” Dr Atkin said.

“Usually the patient has been happy to delegate to family members or has wanted limited information and the family have been relatively accepting of this.”

A woman with her arm around a child near a grave. — Sarah Jones feared that her children would get depressed if they found out about her prognosis.

However, Dr Atkin said the practice of “non-disclosure” in Western countries could present conflicts between ethical principles which needed to be “weighed against each other”.

“Modern Western cultures tend to have a strong focus on the importance of the individual patient’s autonomy, and the individual making decisions about their own healthcare based on the full information provided by medical teams,” she said.

“Withholding information and making treatment decisions without the patient’s involvement can result in a form of paternalism, affect the patient-physician relationship and the patient’s trust in the doctor.”

Meanwhile, Elizabeth Utting, a senior associate in medical negligence at Law Partners, said as well as the ethical implications there were also legal ones in Australia.

“A medical negligence case could arise where withholding such a diagnosis meant that the patient could not receive medical treatment they required to improve their illness or prognosis,” she said.

“A medical negligence case could also arise if a patient’s prognosis was not communicated to the patient, and the patient suffered mental harm as a result of the delay in informing them of the prognosis.

“A doctor’s ethical and legal duty lays with their patient, not their family members.”

An act of love?

It’s not just children who withhold information from elderly parents.

For Filipino-Australian Sarah Jones it was the other way around.

She was 59 years old when she was diagnosed two years ago with terminal uterine cancer and given three months to live.

Her sister, Jessica Cruz, told the ABC Ms Jones decided to keep the prognosis a secret from her children.

“Only my brother-in-law and I knew,” said Ms Cruz, who asked to use pseudonyms for herself and her sister.

“She begged us not to tell her children about it. She continued to tell her kids that it was curable.”

Ms Jones worried about her children’s mental health and was afraid they would get depressed.

“She just wanted them to live a normal life,” Ms Cruz said.

When Ms Jones lost the ability to walk, Ms Cruz told her it was time to tell her children.

“I told her that they had the right to know and that they would understand — but really, I just wanted them to stay with their mum because time was running out,” she said.

Child holding a bouquet of flowers in front of grave — Sarah Jones died four days after turning 60 in hospital.

Her children found out about her condition from their father, and after seeing her son cry Ms Jones was upset.

But the next day she felt better about the situation.

“They were now prepared,” Ms Cruz said.

“There were no more secrets.”

Deputy director of palliative care at Melbourne’s St Vincent’s Hospital Jennifer Weil said there were many cultural, religious, and personal factors that went into decisions about how much information people wanted shared, especially in relation to terminal illness.

“The challenge for us as doctors is to seek to explore and understand, and avoid our own beliefs and values directing how we share information,” she said.

A women smiling at camera — Jennifer Weil says doctors need to make the effort to understand cultural beliefs.

Dr Atkin said if a patient, based on their cultural beliefs, decided not to have their diagnosis or prognosis disclosed to them, it did not necessarily go against the principle of autonomy.

“My approach is to understand the wishes, preferences and concerns of the family and the patient regarding medical information, explore these sensitively and reassure the family that their loved one will not be given information they don’t want to receive,” she said.

A good lie?

During the first few days after we got my grandpa’s prognosis, I did not want to lie to him — but I felt I had to respect my family’s decision.

Then, towards the end, I began to understand where my family was coming from.

We lied to him because we loved him. We wanted my grandpa to live his last remaining days in happiness instead of pain and grief.

And he did.

A close up of an older person's being held by another person. — Mishelle Tongco’s family spent their last moments with her grandpa in peace.

The last time I saw my grandpa was the day before he died at a hospital in Melbourne’s western suburbs.

Surrounding his bed was his wife, children and grandchildren. We all stood quietly.

“Thank you, my wonderful family,” he said as he looked up at the faces of his loved ones.

“I’d like to go home now.”

He closed his eyes.

“You will go home soon,” my sister told him.

“We will be at home waiting for you.”

Complete Article ↪HERE↩!

May 7, 2023May 7, 2023

Finances After The Death of a Spouse

– Creating a “Just In Case” Checklist

By Kyle Prevost

Preparing for the death of a spouse has got to be one of the worst personal finance tasks out there.

I think it might be slightly easier for us to prepare for our own demise than it is to place that burden on our spouse. That statement is especially true if your household division of labour is “the norm”, in that one spouse generally defaults to handling most of the financial planning and paperwork.

As I’ve been writing more and more about retirement lately, the idea of a “just in case” file or a “just in case” checklist has come up more and more. I’m not just talking about complicated tax issues to consider when a spouse passes away, or complex estate maneuvers. I’m more referring to how to handle the basic nuts and bolts of day-to-day life.

And remember, if you’ve decided that one spouse is going to be chiefly responsible for the finances, that individual does not have to pass away for a very bad scenario to occur. Cognitive decline is an unpleasant reality for many of us, and there is no obvious way to tell that someone has reached the point where they are decisively not able to handle the household finances any longer.

Planning sooner rather than later for that day is a responsible way to handle an unpleasant situation.

Financial Planning for Death

While financially planning for the death of a spouse – or your own trip to that great tax haven in the sky – is one of the least fun afternoons that I can contemplate, it is quite likely to head off some truly awful scenarios down the road.

Before preparing a “what to do when a spouse dies checklist” like the one below, let’s just get this important step out of the way first and foremost: You really do need to get that Will, Advanced Care Plan (often called a “living will” thanks to US media), and Power of Attorney set up if you haven’t already.

Yes, it’s boring – but it doesn’t have to be time consuming and expensive. I wrote about my personal experience creating a will a few years ago. It cost me $32 and took about an hour.

Also, consider taking an additional half hour to designate the recipient of non-financially valuable possessions that may not have made it into your will. I know several family squabbles that were caused by a combination of grief and irritating disputes over family heirlooms or relatively small possessions that seem much more important after someone has passed away.

What to Put In My “In Case I Die” Checklist

1) A “How To” for Notifying Service Canada of Your Death

Your OAS benefits stop when you do. Your CPP benefits on the other hand are a bit more complicated. You can read our Ultimate CPP Guide for more benefits information, but the most pressing issue will be collecting the death benefit that is part of the program.

2) Transferring Registered Accounts to Surviving Spouse

Ideally you have read our What Happens to Your TFSA and RRSP After You Die article and have identified the beneficiary and successor holder on your accounts. Those accounts will now have to be transferred to your name solely.

3) Removing Name From Shared Accounts and Utility Bills

When someone passes and is survived by their spouse, their name needs to be taken off of shared accounts, as well as utility bills, etc. A list of these accounts will come in really handy.

Settling and Cancelling Credit Cards

If you are always the one that paid the credit card, directions on how to do that, and then cancelling the credit card (or removing one name from the account) are essential.

5) A visual Step-by-Step Cecumulation Plan if You’re Still Managing Your Own Assets – or Revisiting The Idea of an Annuity/Robo advisor.

Robb Engen over at Boomer and Echo was the one who alerted me to the issue of one spouse often being the household “Chief Financial Officer” – and then passing away – leaving a huge burden of responsibility on the remaining spouse when it comes to maintaining the household decumulation plan.

Robb is a big fan of shifting over your assets to a robo advisor sooner rather than later, as they can assist a surviving spouse with basic retirement income mechanics such as selling investments and moving money to a chequing account. They’re also a great option for automating a RRIF drawdown for example.

I think as one gets older and knows their days of handling complicated decumulation strategies are starting to recede into the rearview mirror, the idea of revisiting the idea of annuities really makes a lot of sense.

Regardless of what path you choose, some combination of current-day learning, easy-to-understand graphic organizers showing a step-by-step process, and very specific directions as to what to do with investments, should really be a priority.

Remember, this stuff can be like a very intimidating new language for non-financially savvy folks. We’re looking at a situation where a spouse will have to learn that new language as they grieve and take care of 101 other things. Making things as easy as possible will be much appreciated.

6) A Passwords List

This can likely be combined with the “important stuff binder” below. A non-hackable physical document that either provides simple hints to passwords, or partial passwords, should be written out and stored in an ultrasafe location such as a safety deposit box.

Just think about all the passwords your digital footprint likely includes these days. Take a half hour and make this simple.

7) Navigating Probate and Life Insurance

As part of your will you should think about how the sequence of events will occur once you pass away. Our life insurance for seniors in Canada guide will explain both why you shouldn’t get talked into insurance that you don’t need, as well as what happens to a life insurance payment when you pass. Make sure all of the relevant contact details and the processes involved are easy to find.

8) A Physical Binder of “Important Stuff” For a Safety Deposit Box

In this day and age of online storage you might prefer to make copies of important documents and store them in a super safe online storage solution. But personally, the vast majority of folks that I know are still reassured by the idea of a physical copy of something in a safety deposit box.

Upon your death or the death of a spouse having important documents like birth certificates, marriage licenses, lists of accounts and/or loans, property deeds, pension information, contact details of professionals that you depended on such as accountants or advisers, etc – easily accessible will greatly reduce stress during an inevitable stressful time.

You can also put copies of keys in this binder as well if you really want to make life simple.

Consider leaving a copy of that binder with the trusted individual who will be the executor of your will.

Conclusion – How to Plan for the Death of a Spouse or Loved One

From my limited experience, there is no real way to prepare for the emotional trauma of losing a loved one. That said, there is no need to compound that grief by failing to prepare financially for the death of a spouse or your own demise.

Getting your affairs in order sooner rather than later can mean saving untold heartaches and headaches down the road, so I really do think it’s worth taking the time to do it right.

Complete Article ↪HERE↩!

May 6, 2023May 5, 2023

The End of Life Debate

— More states and countries are enacting laws to let terminally ill patients in great pain decide for themselves when to die

By Donna Apidone

In January, just a few days after the start of 2023, a woman walked into the Daytona Beach, Florida, hospital where her terminally ill husband was a patient and shot him. She said she intended to kill herself as well, but hospital staff stopped her before she could carry out the second part of her plan.

Ellen Gilland told police the shooting was by mutual consent, that she and her husband agreed that it was the best way for them to handle his decline in health. He was too weak to take his own life.

A person holding a "end of life consultation" pamphlet. Next Avenue, end-of-life debate, medical aid in dying — A 2020 Gallup poll showed 74% of Americans surveyed said doctors should be allowed to end the life of a patient with an incurable disease “by some painless means” if the patient and the patient’s family requests it.

Only 10 states and the District of Columbia have laws that allow medical assistance in dying by making a lethal dose of medication available to adult patients who request one. The practice also is legal in Montana because of a court ruling.

Medically assisted deaths are illegal in all other states and U.S. territories, including Florida. No jurisdiction permits the use of firearms to end a human life.

Words Matter

Medical aid in dying is not euthanasia. The latter term includes the act of one person killing another who is terminally ill or hopelessly injured and suffering great pain. Euthanasia is illegal throughout the United States. However, if the person who is dying self-administers, the act is not considered euthanasia.

Only 10 states and the District of Columbia have laws that allow medical assistance in dying by making a lethal dose of medication available to adult patients who request one.

In the U.S., terminology has evolved. The current acceptable wording is “medical aid in dying” or “medical assistance in dying” indicating that a medical professional will make a lethal dose of one or more drugs available to the patient but leave it to the patient to decide whether to take it. The terms are abbreviated as MAID.

The word “suicide” is not accurate, although is it sometimes incorrectly applied. Death certificates state a patient’s underlying illness as cause of death.

Although 22% of Americans have access to medical aid in dying, fewer than 1% of people in the 10 states and Washington, DC, where this option is legal actually obtain the medication, and only two-thirds of them ultimately decide to take it, according to Compassion and Choices, a nonprofit group that advocates for end-of-life options including, but not limited to, medical aid in dying.

Where It Is Legal in the U.S.

In addition to reaching a consensus on the language describing medical aid in dying, the 11 jurisdictions that authorize the practice are consistent in their intent, said Kim Callinan, president and CEO of Compassion and Choices.

“Most of the laws across the states are very similar,” she said. “The eligibility criteria are the same. And the safeguards are the same.”

Geoff Sugerman, who served as campaign manager for Oregon’s Death with Dignity law, which was enacted in 2012, and works closely with the national organization called Death with Dignity, laid out the four cornerstones of the laws in in the 11 jurisdictions:

Patients must be adults with a terminal illness and a prognosis of six months or less to live.

Attending physicians must verify patients are acting voluntarily.

Patients must be able to make and communicate their decision to health care providers.

Patients must be able to self-administer (ingest) the medication.

Differences Among Laws

There are some differences in the laws. Where it is legal, a common waiting period for approval of medical assistance in dying is 15 days. Hawaii mandates 20 days. New Mexico and Oregon are less than 15 days. In California, a 2022 adjustment to the law reduced the time from 15 days to 48 hours.

Kim Callinan, Compassion & Choices

Most medically assisted deaths are limited to residents of states that have legalized the procedure. However, the Vermont legislature in April passed a bill that would eliminate the residency requirement; Gov. Phil Scott has said he would sign it into law. Meanwhile, Oregon officials have said the state will not prosecute non-resident cases.

The number of states considering medically assisted death continues to grow. Minnesota and Florida have bills in their legislatures.

Fine-Tuning Legislation

While some states debate new MAID laws, others are weighing changes to existing laws. As public opinion adjusts and data is collected, legislators in several states are considering amendments. Some details in the original laws may have “served as barriers to the patient,” Sugerman explained.

Changes to legislation may include the length of the waiting period and expanding the definition of “medical professional” to include Physician Assistants and Nurse Practitioners. Some states may remove their residency requirements so that patients can travel from other jurisdictions for the process.

Details and updates about state legislation are available through Compassion and Choices and Death with Dignity.

Complete Article ↪HERE↩!

May 5, 2023May 4, 2023

How do I navigate grief in my twenties?

By Julia Presenza

Growing around your grief.

In your twenties, you’ll find some of your closest friends nursing hangovers from overindulging in vodka Red Bulls, overanalysing text messages and hoping no one saw them doing the walk of shame. On the other end, others are getting married to the loves of their lives, buying houses and having babies. We’ve all had these conversations before – everyone around you seems to be in different stages of life and needless to say, everyone is doing their best.

Still, there’s no how-to guide on ensuring you’re doing it all correctly. It goes without saying there’s no handbook outlining what to do when something major comes around and blows up your life as you know it, especially when it’s a life event you weren’t even considering could happen this early on.

Deep down in the back of our minds, we know eventually, one day in the far future, we will all have to deal with the loss of someone close in our lives. Call me naive, but dealing with grief wasn’t something I thought I’d have to add to the list of worries in my twenties. It seems almost unfair to be entering a point in life where I’m still trying to perfect the schedule of which night I should wash my hair and fake tan, to be then hit with the Earth-shattering experience of dealing with death.

Over recent years, I’ve had personal experiences navigating grief, from losing my dad to losing close friends of family members. As many self-help books will mention, the grieving process will be different for everyone. It’s one thing to try and navigate your own grief, and another trying to be the support person for someone else.

I experienced constant guilt of feeling someone else’s pain but never knowing what it actually felt like for them. I have three sisters, along with my mum, and while we all were experiencing my dad’s loss together, it was very apparent we had different ways of dealing with grief. With many questions circling in my head, I spoke to Carly Dober, psychologist and Headspace App’s Mental Health Expert, to get clarity.

How to navigate losing someone close to you while also being the support person for someone else

Carly acknowledges this can be incredibly difficult to navigate but states it’s important to honour and give your feelings of grief and loss enough time and attention. Often, people will jump into caretaker mode as a distraction from their pain but this can prolong the process of grieving for ourselves. Grieving is a shared effort. She mentions we can often find solace in others who are in pain, too. It’s important to be there to support your loved ones through this difficult time but also lean on your friends and networks so you’re also cared for and fully supported.

How to be supportive when multiple people are grieving the same person differently

Carly says this is very common, “We each have unique relationships with people, so how we will experience their loss is also unique. I’d recommend showing your support but also not lying”. Saying things like, ‘I know you had a very close relationship with them and I’m so sad that this is happening to you’, ‘How can I best help you through this?’ and ‘What do you need from me right now?’ are ways of showing your love for the person grieving while also honouring your relationship with the deceased.

How do you cope with the loss of different people within a short time?

Unfortunately, life isn’t fair. Carly recommends seeking support from a mental health professional early. Losing people is difficult enough, and the chronic stress of losing multiple people in a short time frame can be very destabilising. It’s encouraged to avoid any tempting but ultimately unhelpful coping strategies (such as self-medicating with drugs and alcohol) with helpful ones (such as routines, movement and rest).

Lean on close relationships, be social in whatever capacity you can and engage with pets and nature. Carly suggests clearly expressing your needs to others is also helpful in coping with the loss of multiple people.

What should you do about feeling guilty about moving on and not wanting to be sad anymore?’

Carly points out grieving can make us feel like life will never be the same again. Accepting that life goes on despite the difficulties can be the most challenging truth. Carly’s words were reassuring as she clarified that moving on from losing a loved one doesn’t mean we loved them or are hurting any less. It simply means we’re adapting to life without them and growing around our grief. Grief is a natural part of life; many of us experience it from a young age, while others learn this lesson later in life.

Just like the journey of navigating your twenties, there’s no correct or incorrect way to grieve. It’s crucial to express your emotions with those close to you and give yourself time and understanding to ease you through the difficult moments in life. It’ll make the grieving process a little less painful.

Complete Article ↪HERE↩!

May 4, 2023May 3, 2023

Vermont Removes Residency Requirement for Medically Assisted Deaths

— The change, signed into law by the state’s governor, followed a legal challenge brought by a 75-year-old Connecticut resident.

Lynda Bluestein is the first nonresident to be granted medically assisted life-ending care in Vermont.

By Livia Albeck-Ripka

Vermont has become the first state to remove a residency requirement from its law on medically assisted death to allow terminally ill people from out of state access to life-ending care.

The law, which for a decade has permitted doctors to prescribe life-ending medication to terminally ill people 18 or older, was amended Tuesday, when Gov. Phil Scott signed a bill scrapping the residency requirement.

The measure passed Vermont’s Senate and House last month following a legal battle brought against the state by a 75-year-old resident of Bridgeport, Conn., who has late-stage fallopian tube cancer and argued that Vermont’s restriction was unconstitutional. The state waived the residency requirement for the woman, Lynda Bluestein, as part of a settlement in March.

“I was always hoping that the Legislature would change the law and make it open to everyone,” Ms. Bluestein said by phone on Tuesday. “I was really thrilled.”

While Vermont is the first state to formally remove the residency requirement from its medically assisted suicide law, Oregon health authorities agreed in 2022 to stop enforcing its residency provision as part of a settlement in a similar federal lawsuit. A bill seeking to remove the requirement has since passed Oregon’s House. The state was the first to pass a medical aid in dying law, which took effect in 1997.

Several other states and the District of Columbia allow terminally ill residents access to life-ending treatments, but most do not permit nonresidents to access their care.

Advocates for improving end-of-life care said on Tuesday that they hoped other states would follow Vermont in allowing people to cross state lines to end their lives with dignity.

“Support for this is widespread and bipartisan,” said Kimberly Callinan, the chief executive of Compassion & Choices, an advocacy group that supports expanding access to end-of-life medication. “People universally want to be able to make decisions over how they die.”

But critics of assisted-dying laws argue that the practice remains a matter of contention. “There continue to be legitimate and serious concerns,” Mary Hahn Beerworth, a lobbyist with Vermont Right to Life, testified before a legislative committee earlier this year.

“Vermont Right to Life opposed the underlying concept behind assisted suicide and opposes the move to remove the residency requirement as there are still no safeguards that protect vulnerable patients from coercion,” Ms. Hahn Beerworth said. She noted a number of other concerns, including what might happen if the patient decided not to use a lethal dose of drugs, and instead took it back to their home state. She added, “If the drugs are taken and death occurs in Vermont, what happens with the body?”

Jennifer Popik, a spokeswoman for the National Right to Life, said in a statement that the organization was “deeply disappointed that Vermont is now poised to become a tourist destination for assisted suicide.” The laws, she added, posed a danger to “vulnerable groups.”

But Cassandra Johnston, 38, a resident of New York who has stage three breast cancer, said that Vermont’s law change on Tuesday had given her peace of mind, knowing she could go to the state to access care if needed. “This should be the standard of medical care, not the exception,” Ms. Johnston said.

Ms. Bluestein, whose legal battle preceded Vermont’s rule change on Tuesday, said that she still planned to go there when the time came for her to request life-ending medication.

Having such an option, Ms. Bluestein said, meant she could die on her own terms, surrounded by her family. She added, it’s “a tremendous relief.”

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May 3, 2023May 3, 2023

Death Cafes

— You’re Going Where?

By Marilyn Mendoza

The Death Positive Movement

In Victorian England, death was in the forefront of society. People would begin talking and planning for their death when they were young. By the time someone died, there was no doubt about what was wanted and how it was to be carried out. Women would even make their shrouds to be included in their wedding dowry.

Since that time, we have made a complete reversal in how we deal with death, from being the center of one’s life to rarely being discussed. However, continuing to ignore it will not make it go away. Death is coming for all of us.

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In 2011, the Death Positive Movement began. Since then, it has been providing opportunities for people to talk more openly about death and dying. Its goal is to decrease the stigma of death. However, many people are still unaware of the movement and the activities associated with it. Perhaps one of the better-known activities associated with the movement is the Death Cafe.

Quite simply, Death Cafes are places that you can go, for free, to feel comfortable and safe talking about death. Actually, you do not even have to talk if you don’t want to. There is no planned agenda, and anyone can bring up a topic to discuss. It is free. Cake and tea are always served and sometimes other beverages. The Cafes are currently found in at least 80 different countries. Sometimes the group may be run by a mental health professional, though most of the time it is someone who has no training in groups or mental health.

While Death Cafes are not meant to be support or therapy groups, I have generally found that people who attend these meetings are warm and supportive of each other, sharing a common bond in accepting mortality. Other activities associated with the movement are Death with Dinner and Coffin Clubs. Often Death with Dinner consists of smaller groups who might get together at someone’s home for dinner and discussion about death.

Coffin Clubs have been popular in New Zealand, England and Ireland, although I am unaware of Coffin Clubs in the United States. People get together to build, decorate and try out their coffins. Members enjoy being with each other. It is a safe place to talk about their lives and future death. An additional benefit to the Coffin Club is the significant amount of money saved by building their own coffins.

Death Cafes and Therapy

Of the three activities, my clients and I have experienced the Death Cafe. I attended the first Death Cafe held in New Orleans and was amazed by the number of people who came. It was a mixed group, with some being from the medical and mental health fields, while most of the others were from the community. They had heard about the Death Cafe and came to see what it was all about. It was a unique experience.

You don’t usually find people sitting around talking about death. However, it was very encouraging. For over an hour, we introduced ourselves and talked about what had brought us to the meeting. Some came due to curiosity, some due to the loss of a loved one, and some with their own terminal condition. All were interested in discussing and learning more about death. It is good to be able to see that others have the same concerns and fears about dying as we do.

During the meeting, I began to reflect on the people in my practice who might benefit from this experience, and then I thought about Sarah. Sarah was a 74-year-old woman who came into therapy to talk about her declining health. She had been diagnosed with congestive heart failure, which was worsening. She felt that she would not be alive for much longer and wanted to talk about dying.

The problem was that her family did not want to accept her impending death or talk about it — an all-too-common experience. I talked with Sarah about considering attending a Death Cafe meeting. It didn’t take much to convince her.

The following week when she returned, she talked about her experience and how it was like a “breath of fresh air” for her. “People were so welcoming and open,” she said. “It was a relief to be able to talk about dying and not feel guilty. I’m glad I went. I feel like I learned a lot.”

The meeting seemed to empower Sarah. She decided that she wasn’t going to wait around for her family and that she just needed to take charge of all the planning herself so she could have everything just the way she wanted. She began to plan her funeral, the music, and the dress she wanted to be buried in. She picked out her gravesite and even designed her own headstone.

I have also encouraged trainees who were interested in palliative care to have the Death Cafe experience. It has been a great learning tool and helps them to be more comfortable when talking about death with others.

Tulane Medical school has also been in the forefront of utilizing the Death Cafe as a way to address burnout in medical staff who work in high death areas such as the ICU. The meeting I attended included medical staff who worked together on a surgical unit. A child had died in surgery, and the doctor who had performed the surgery was sharing the impact on him as well as the other staff present.

It was very touching to hear him. His pain was almost palpable. Perhaps most striking to me was the atmosphere of the group that allowed him to be open with his feelings of sadness and to cry at the loss of his patient. There are perhaps many different providers who work with the dying that could benefit from debriefing Death Cafes.

Of course, not everyone is enthusiastic about learning more about death. In my practice, I have found that women tend to be more open to the idea than men. There was one situation that has stayed with me for years that demonstrates the power that the fear of death can have: Patricia was brought to therapy by her husband at her doctor’s request. She had been quite ill and recently diagnosed with cancer. Her husband brought her in because the doctor said she was depressed.

It was hard to determine if she was more afraid of her husband, or of dying. One day, she told her husband what we had been talking about. He flew into a rage and would not let her return. It is this fear that speaks to the need for Death Cafes to normalize the process and free people up to talk about what is ahead for all of us.

The Death Cafe has a saying: “talking about babies won’t make you pregnant and talking about death won’t make you die.”

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