Assisted Dying – Page 40 – The Amateur's Guide To Death & Dying

October 22, 2015

Home Is Burning: the profanity-laced terminal illness memoir with fart jokes

Dan Marshall’s book about his father’s death – while his mother was stricken with cancer – is possibly the most scatalogical memoir of its kind ever, and now Hollywood has come knocking

002 — The Marshall family on 22 September 2008, the day of Bob’s death. (Left to right): Dan, Michelle, Tiffany, Bob, Chelsea, Debi, Greg.

Dan Marshall sips an iced coffee under a Los Angeles sun and mulls the notion of Hollywood sanitising his memoir, the story of how he and his siblings dealt with terminally ill parents during an anguished year in the Mormon capital of Salt Lake City. Marshall shakes his head and gives a faint smile. “It’d tear the balls off the thing if they made it PG-13.”

It would indeed. Home Is Burning, published this month and due to be made into a film, dives deep into the pain and grief of caring for a father who slowly wastes away, and a mother who hovers close to death. It also plumbs the cacophonous dysfunction of a family stumbling through the ordeal with black humour, fart jokes, painkillers, booze, feuds, sex and swearing – epic, ungodly, obscene, unrepentant, relentless swearing.

“It’ll have to be R-rated,” says Marshall. “There’s a lot of death and dying but with South Park humour applied to normally difficult and sentimental situations. I’m making jokes about wiping my dad’s ass.”

The 300-page memoir jokes about everything: the cruelty of amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease, which killed Bob Marshall in 2008; the brutal side effects of Debbi Marshall’s cancer treatment; the vicious sibling arguments; the pious Mormon neighbours.

One unforgettable section details Debbi’s declaration that she will perform oral sex on her husband – by then confined to a bed and respirator – daily until he dies. “My mom was beyond proud of the blow-job-a-day goal. I don’t know if it was because she was all fucked up on Fentanly or what, but she seemed to bring it up any chance she got. ‘A blow job a day. Not a bad deal,’ I heard her explain to a visitor. ‘You wouldn’t think it, but his penis is still strong.’”

003 — Debi with Bob, the day before his death.

The Marshall clan is barging into a terminal illness genre rife with sentimentality – think The Fault in Our Stars, Before I Die, Tuesdays with Morrie – with a unique strain of profane, scatological humour. Prominent memoirists have endorsed Home Is Burning. James Frey, author of A Million Little Pieces, called it hilarious and heartbreaking. Justin St Germain, author of Son of a Gun, deemed it self-aware and ruthlessly honest: “Dan Marshall might be a self-described spoiled white jerk, but he’s also a depraved comedic genius.” Publishers Weekly called him the literary love child of Dave Eggers and David Sedaris.

In person Marshall, 33, is softly spoken, almost shy. He mocks himself in the memoir as a dumpy, boozy, gummy bear-chomping screw-up. But the figure who settles into the corner of a restaurant terrace, seeking shade on a baking afternoon, is somewhat reformed. He has quit drinking, jogs and has, by his own measure, matured.

Conjuring success from tragedy has been bittersweet. His beloved dad is dead and his mother is still ill – loss and pain which redirected Marshall from a job in public relations.

He chronicled his experience as a caregiver in Facebook posts: raw, unfiltered outbursts alternately expressing solidarity with and resentment at those around him, and bewilderment at their predicament. After his father’s death Marshall moved to LA, studied screenwriting and found a toehold in Hollywood writing comedy. The memoir, his first book, has vaulted him into another league.

The independent studio New Line snapped it up and contracted Marshall to turn it into a screenplay. Jonathan Levine, who directed the zombie comedy Warm Bodies, will direct the film and Miles Teller, the star of Whiplash and Divergent, will play Marshall.

“I was on track in the corporate world before dad got sick,” he says, stirring melting ice. “It changed my path.” It feels strange to be on the cusp of celebrity. “I feel less of a fraud. But it’s weird because no one knows who the fuck I am.” He pauses. “Some mornings I still wake up and feel like such a loser. I’ve no girlfriend and I write fart jokes.” He smiles but is completely serious.

Back in 2007, Marshall was in his first post-college job, enjoying independence from his family and dating his dream girl, a charmed “dicking around” existence. Then out of the blue the phone call which changed everything: your dad has ALS, come home.

After some hesitation, he did. The family lived in a big, plush house in Salt Lake City, the only non-Mormons in their neighbourhood. His mother, who had been battling non-Hodgkin’s lymphoma since 1992, was a spirited but ravaged chemotherapy veteran whose survival confounded doctors. She cursed like a sailor even before her life hung by a thread.

Bob had been the family’s anchor, a calming, levelheaded businessman who ran several small newspapers, nursed his wife, guided his children and competed in marathons. He was 53 when he was ambushed by the neurodegenerative disease which would gradually paralyse and asphyxiate him.

Debi decreed the family would care for him at home even though she was weak and woozy from medication. Dan’s sisters were also constrained. Tiffany, the eldest, was tied up with studies, work and a boyfriend (nicknamed “big cock Brian” after an ill-advised admission to her mother), and alienated by the arrival of Dan, who bullied her.

Chelsea was a troubled teen who drank too much and was having, it emerged, a clandestine romance with her soccer coach. Michelle, also a teen, had Asperger’s and struggled to understand her father’s plight. She sought refuge in dance and lavatorial jokes, which delighted Dan but no one else.

005 — Dan Marshall: ‘Tom Hanks playing Bob would be bonkers.’

The burden of care fell mainly on Dan and his brother Greg, who returned from university in Illinois, where he had enjoyed the freedom to be gay that was denied him in Utah. They converted a bedroom into a de facto intensive care unit, learned how to use a respirator, transported their father in a wheelchair and rickety bus, and bathed, changed and fed him.

As Bob turned skeletal and lost his voice, mother and siblings fought, reconciled and fought anew, with Dan and Tiffany in particular flaying verbal strips off each other. “Everything in that situation was heightened,” Dan recalls. “And I was a lot more rambunctious, and drinking. When you’re around family you’re more free in what you say and do because they’re family and will still love you no matter what. People’s true colours come out.”

A fierce devotion to his father sears through the pages. “It would have been easier if I’d hated him. But I loved him. He was such a good guy.”

Bob Marshall was stoic about his plight – and the sometimes chaotic, X-rated efforts to care for him. Dan programmed his Stephen Hawking-style communication device to include an icon with a limp penis. When clicked, it said: “Boy, I could use a blow job.” The line cracked up the family and prompted a tender unity: “Dad in the heart of the house, his little bald wife by his side, his children resting their hands on his shoulder. We all took in the moment.”

As other dramas unfolded in the wings – Chelsea marrying her soccer coach, Dan going on an ecstasy-fuelled one-night stand after his girlfriend dumped him – Bob Marshall eventually decided to end his agony. He decreed that the respirator would be turned off on 22 September, the first official day of autumn, his favourite season. The family, nerves shredded, weepy and frightened, referred to it as the “big unhook”. A doctor ensured there was no pain. Neighbours’ children released balloons into the sky.

Debbi is the star of the book, a fighter and survivor often half-crazed by medication. She has since had a mastectomy and now wears a wig. “She keeps texting me ideas about who should play her – Meryl Streep, Sandra Bullock, Laura Linney. But I tell her we’ll get Danny DeVito,” says Dan. There is talk of Tom Hanks playing Bob. “That would be bonkers. My dad loved Forrest Gump.”

The screenplay has a rom-com structure: selfish oaf learns life lessons and falls back in love with his family. It happens to be true, says Dan. He has reconciled with Tiffany and feels closer than ever to his family, all of whom, after some hesitation, blessed the book. His advice to other families facing similar ordeals: “Spend as much time as you can with each other. And forgive each other. Whatever resentments you’re hanging on to, let go.”

Complete Article HERE!

October 20, 2015

Will California’s end-of-life law push lethal drugs over costlier care?

Kevin McCarty, Susan Talamantes Eggman, Jay Overnolte — Assemblywoman Susan Talamantes Eggman (D-Stockton) is congratulated by Assemblymen Kevin McCarty (D-Sacramento), left, and Jay Obernolte (R-Big Bear Lake) after her right-to die measure was approved by the full Assembly in September.

By Soumya Karlamangla

Terminally ill cancer patient Barbara Wagner’s doctor wrote a prescription several years ago intended to extend her life a few extra months. But Oregon’s government-run healthcare program declined to pay for the pricey drug, saying the projected odds of the medicine’s keeping her alive were too low.

Adding to the distress of the rejection, Wagner later complained publicly, was what else was included in the denial letter she received. The state listed doctor-aided death as one of the treatment options that would be completely covered.

“[They] basically said if you want to take the pills, we will help you get that from the doctor and we will stand there and watch you die, but we won’t give you the medication to live,” Wagner said in a television interview at the time.

Wagner’s case became a flash point of the medical ethics debate over helping the terminally ill end their lives in Oregon, the state that pioneered the practice in the U.S. nearly two decades ago.

Now, as California pushes ahead with a similar initiative, experts say state officials here could face their own ethical controversies as they weigh details such as who should pay for life-ending care, particularly for patients in government-backed health plans.

Covering lethal prescribed drugs for such patients without also offering to pay for other far more costly end-of-life treatments could inadvertently pressure people into choosing the cheaper option, said Dr. Aaron Kheriaty, a UC Irvine psychiatrist and director of the university’s medical ethics program.

“It’s certainly a cost-saver,” he said.

Supporters of California’s law and other experts say it ensures life-ending decisions will be left to patients and that covering drugs that aid in dying won’t push people to make that choice. So few people will opt for doctor-assisted deaths, they argue, that the financial savings will be tiny compared with overall healthcare costs and won’t create a significant economic incentive for insurance carriers to even subtly encourage that medical alternative.

Under California’s End of Life Option Act signed by Gov. Jerry Brown this month, physicians, starting sometime in 2016, will be allowed to prescribe lethal drugs to adults diagnosed with terminal illnesses who are expected to die within six months and request assistance to end their lives.

The law does not require private insurance companies to cover such medicine. And state officials with Medi-Cal, the health program for the poor that covers more than 12 million people, say they haven’t determined whether their plan will pay for such treatments.

A state legislative committee analysis concluded that any costs or savings for Medi-Cal from legalizing doctor-aided death would be minor, depending on whether the lethal drugs are covered. The biggest projected expenditure would be about $323,000 to set up and operate a data system to manage paperwork associated with the program.

Many health advocates and experts expect Medi-Cal, like Oregon’s state-run health plan for the poor, to cover the life-ending treatment.

William Toffler, a family physician in Oregon, says California would be making a mistake. He contends that Medi-Cal officials would be forced into a new and significant ethical dilemma, balancing their responsibility to control costs and ration care with ensuring that patients receive the most effective medical treatment possible. The barbiturates prescribed to patients to end their lives cost about $1,500. Average healthcare spending in a patient’s last year of life is $33,486, according to federal data.

“It’s a terribly wrong-headed move. It’s a conflict of interest for doctors; it’s a conflict of interest for the state,” Toffler said.

Vermont and Washington — which more recently permitted physicians to write lethal prescriptions — and the federal government’s Medicare health plan do not cover the drugs. Representatives from both state programs declined requests to discuss their reasoning.

Officials from Oregon’s health plan say that physician-assisted death is just one of many covered medical options offered to terminally ill patients, along with hospice care and pain medications.

Wagner was told in 2008 that she had only a few months to live. She was prescribed a medicine that might have extended her life for a limited time, at a cost of $4,000 a month. Oregon’s health plan denied coverage, based on a policy that requires treatments to provide at least a 5% survival rate after five years.

Advocates said the case was blown out of proportion by the media and critics. The denial of the costlier drug wasn’t because of its price, but its low efficacy, they said.

“Barbara Wagner was not harmed by the Oregon aid-in-dying law. She was not harmed by the Oregon Medicaid system,” said Barbara Coombs Lee, president of the groupCompassion & Choices, which pushed for the law.

After the media focused on the case, the manufacturer of the drug prescribed by Wagner’s doctor offered her the pills free of charge. She died soon thereafter.

Oregon health officials subsequently halted the practice of listing lethal drugs as an alternative treatment offered to terminally ill patients who were denied other treatments under their coverage.

“I think the state Medicaid system learned to be a little more tactful,” Coombs Lee said.

Apparently learning from Oregon’s experience in Wagner’s case, California lawmakers included in the new legislation that insurance plans are prohibited from including in a treatment denial letter information on the availability of aid-in-dying drugs.

Christian Burkin, a spokesman for Assemblywoman Susan Talamantes Eggman (D-Stockton), who wrote the bill, said that “no one should be subjected to even the appearance or suggestion of being influenced to choose the end-of-life option.”

Some fear the pressures to choose assisted death could be more subtle.

Daniel Sulmasy, a physician and medical ethics professor at the University of Chicago, concluded in a 1998 research study that physicians inclined to conserve resources were more likely to write lethal prescriptions for terminally ill patients than those not concerned about keeping costs down.

That’s particularly worrisome, Sulmasy said in an interview, as California tries to manage the growing costs of Medi-Cal.

Under Obamacare, about a third of all Californians are now covered by the program, and its costs have climbed 74% since 2013 to more than $91 billion a year.

The federal government covers most of the costs but will begin shifting the expenses to the state after next year. California is already struggling with an $18-billion annual contribution, and that will rise in coming years.

Sulmasy also argues that as lethal treatments for the dying become more common, patients could face societal pressures from friends and relatives to unburden their caregivers or avoid racking up medical bills that drain family wealth.

But Oregon patient data have shown little evidence of that, says Coombs Lee, who was a nurse before she cowrote Oregon’s Death With Dignity Law. Of the roughly 860 people who have died in this way in Oregon since the law was enacted in 1997, 98% had state or private health insurance — and private plans tend to cover more end-of-life medical treatments.

Coombs Lee pointed to a new study that shows Oregon has some of the nation’s highest rates of hospice usage — and lowest levels of potentially concerning hospice care. She said that indicates, overall, that the state’s death with dignity law is improving end-of-life care.

“There’s no red flags,” Coombs Lee said.

Ezekiel Emanuel, an oncologist and bioethicist at the University of Pennsylvania, said that doctor-aided death for the terminally ill doesn’t offer insurers much opportunity to cut expenses.

“It’ll have an almost undetectable impact on healthcare costs,” said Emanuel, who helped draft the federal Affordable Care Act.

A 1998 study he conducted estimated legalization of lethal prescriptions nationwide would save less than 0.1% of total healthcare spending, chiefly because very few people would want them.

“It’s a law for the 0.1%,” he said.
Complete Article HERE!

October 14, 2015

California Doctors Get Advice On How To Provide Aid In Dying

doctor-consultation — Doctors may get questions about dosing and timing of medication from patients considering aid in dying.

By April Dembosky

Now that California has legalized aid in dying, advocacy groups are planning statewide education campaigns so doctors know what to do when patients ask for lethal medication to end their lives.

One of the first stops for doctors new to the practice is a doctor-to-doctor toll-free helpline. It’s staffed by physicians from states where the practice is legal, who have experience writing prescriptions for lethal medication.

“We try to answer any doctor’s phone call within 24 hours,” says David Grube, a retired family doctor in Oregon who accepts calls. “I might answer questions about the dose of medicine, the timing of the giving of the medicine, things to avoid, certain kinds of foods.”

Grube recommends prescribing a specific dose of sleeping pills, along with anti-nausea medication. People usually fall asleep within five minutes after taking the drug, and usually pass away within an hour.

This kind of information will also be shared in training sessions, online and at hospitals and medical schools throughout the state before and after the law takes effect in 2016. The precise date is not set; it will take effect 90 days after the end of the ongoing special legislative session.

“Health care systems should start preparing now for their patients who are going to be requesting, and demanding, information about the End of Life Option Act,” says Kat West, policy director for Compassion & Choices, the advocacy group that led the charge for legalization in California and is spearheading the education campaign.

She says a few health care systems in California have called their counterparts in Oregon, where the practice has been legal since 1997, to find out how they have implemented the law there. For example, Kaiser Permanente in Oregon and Seattle Cancer Care in Washington hired patient advocates specifically to respond to requests for aid-in-dying medication and to guide patients and doctors through the process.

Medically-assisted suicide is also legal in Vermont and Montana. But West says California has some key differences that will influence implementation here.

“The challenge, of course, is California is so big,” West says. But “in some ways, California is in a better position to start implementing aid-in-dying, because the infrastructure is already good and in place.”

Opponents have vowed to try to block the law from taking effect.

A group calling itself Seniors Against Suicide filed paperwork this week to put a referendum before voters in November 2016, asking them to overturn the new law. The group needs to collect 365,880 signatures by January to qualify for the ballot, though it’s unclear if they have enough money to run a statewide campaign.

In Oregon, the law was delayed from taking effect for three years because of a lawsuit filed by the federal government. But West says that was 20 years ago, and is unlikely to happen in California.

Californians Against Assisted Suicide, a coalition of religious groups and disability rights advocates who fought the law through the legislative process, says it has not yet decided whether it will sue to stop the law from going into effect.

California’s department of public health will be required to collect and store data about who requests the lethal drugs, and who takes them.

Complete Article HERE!

October 8, 2015October 9, 2015

Doula for the dying: Connecting birth and death

BY AMY WRIGHT GLENN

Amy Doula Dying — Daughters of 97-year-old Utah native William Vance Wright hold vigil.

The last time I saw my grandfather, he was 95 years old. He walked with a bent back. Kindness graced his watery eyes.

During dinner, he asked me how old my son was at least four times.

“Is he 2?” he inquired once again.

“Almost. He’s 21 months, Grandpa,” I answered.

He smiled and returned to eating his tilapia, mashed potatoes and squash.

At the end of our visit, I walked him to the car. As we approached the steps leading down to the garage, he mentioned his bad knee – an injury from the war.

“I can do it,” he said, gently refusing my hand. “Just one step at a time.”

As my uncle opened the car door, my grandpa suddenly stopped. He turned back to look at me. He kissed his hand and lifted it up in the air. I blew a kiss back to him. He “caught it,” then brought it to his cheek with a knowing smile.

The last time I saw my grandfather, he blew me a kiss. That is what I remember most.

Doulas and Dying

I am a doula. I am also a hospital chaplain. In holding space for birthing and dying, I’ve come to see one thing clearly. Standing with an open heart in the presence of birth is very much like standing with an open heart in the presence of death.

The word “doula” translates from Greek to mean “woman servant.” Today, doulas are known best for accompanying laboring and/or postpartum women. Doulas offer emotional, mental, spiritual and physical support during the transition of opening to new life. According to a 2013 nationwide survey conducted by Listening to Mothers, around 6 percent of expectant couples in America hire a birth doula. This number is small, but it’s growing. In 2006, only 3 percent of birthing women had doula support.

The vast majority of American women give birth in a hospital. Given this, the compassionate and consistent presence of a doula offers a healing tonic in an impersonal and medicalized obstetrical setting. Doulas focus solely on providing comfort measures, based on best practices, to ease the pain of labor and steady the heart and mind of a birthing woman. As a doula, I offer support for hours on end. I do my best to mirror back to a woman her courage, beauty and strength. Doulas believe in the power of birth and regard the process of birth as sacred.

What happens when we take the doula model described above and apply it to end-of-life care? What if we doula the dying?

Like with birth, the majority of Americans die in a hospital. While the majority of us wish to die at home, according to the National Center for Health Statistics, only 27 percent of Americans do. Most of us are born and die surrounded by medical professionals and beeping machines. Ideally, the technology associated with important medical advancements doesn’t eclipse the perennial needs of the human heart. Women birth best when they feel safe, are supported, and their bodies are allowed to open with organic wisdom. In the same way, the dying are best comforted with human touch, love, story and song.

In 2003, Henry Fersko-Weiss, a licensed clinical social worker, created the first end-of-life doula program in the U.S. He saw that there was “a gap” that hospice and medical professionals couldn’t fill when it came to supporting the dying and the bereaved. He trained with Debra Pascali-Bonaro, creator and director of Orgasmic Birth and chair of the International MotherBaby Childbirth Organization. Fersko-Weiss transferred knowledge gained about birth doula work to caring for the dying. As president of the International End of Life Doula Association (INELDA), he trains hundreds of individuals, drawing upon his studies of the intersectionality of birth and death work. Today, a small but growing number of organizations wisely build upon the doula model and offer training to support the dying and bereaved.

Fersko-Weiss is unique. Few end-of-life care professionals are trained in birth work. Few birth workers are trained in caring for the dying. Yet, uncanny similarities in best practices exist across these professions. At the October 2014 Midwives Alliance of North America annual conference, I spoke about the overlapping skill set taught in both my training as birth doula and hospital chaplain.There is much to be gained from studying what it means to hold space for both birth and death.

Holding Space

“That sure looks like my brother Darcey,” my grandpa said a few days before he died. His eyes gazed across his room. Then, he added, “Hi Mom. Will you stay close to me today?”

Will you stay close to me today?

When the veil between our visual world and the wonders beyond the physical senses thins, we seek out the hands of loved ones. Whether a mother holds these hands as she bears down to push a beloved child into our world, or whether an elderly woman holds the hands of her children as she breathes her last breath — we reach for each other. We do.

Wisdom and insight are born when we stay close to the birthing and dying. Wounds from the past can be healed. Forgiveness and perspective dawn. Our culture is currently fragmented from much of this wisdom. The training of doulas represents a healing shift. By holding compassionate and nonjudgmental space, doulas support families as they make room for the generations to enter and exit this world. As we attend to birth and death, we touch upon a great mystery and deeply benefit from being starkly reminded of our own mortality.

During my grandfather’s final days, his grandchildren and great-grandchildren came to his bedside. While he received quality and attentive hospice support, it was the consistent and compassionate care of his seven children that mattered most. In particular, my Aunt Colleen’s remarkable devotion to her father made it possible for him to live out his final years and eventually take his final breath in the comfort of his own home. She was his doula.

While the birth/postpartum doula movement makes important inroads in our maternity care system, great commitment and insight are needed to bring doula care to the dying. The elderly are easily disregarded in a culture that worships youthfulness, independence and productivity. Like infants, the dying remind us of our fragility, our dependency and our need for each other. When we sequester either birth or death, we lose touch with the truth of our interdependence, the nesting of generations, and what Buddhist teacher Thich Nhat Hanh calls our “interbeing.”

‘Just one step at a time’

As I work to train death doulas, hold space for the birthing and meditate on the mysteries that connect the threshold points of life, I remember my grandfather’s words: “Just one step at a time.” Yes. Just one birth, one death, one step at a time.

Slowly, steadily, the doula movement brings needed healing to how we perceive and experience both birth and death. Holding compassionate presence in our most fragile moments reminds us of what matters most. Certainly, it’s not what we possess. Even the location of birth or death is secondary. It’s the presence of love and the gentleness we bring to our mortal journey that matter most.

The last time I saw my grandfather, he blew me a kiss. I hold it close to my cheek. It inspires me to do this work.

Complete Article HERE!

October 7, 2015

Inmates Help Other Prisoners Face Death in Hospice Program

By Andrew Welsh-huggins

Inmate Scott Abram sings to a fellow inmate who is dying and is spending his last days in a prison hospice program, on Friday, Sept. 11, 2015 in Columbus, Ohio. Abram, serving 15 years to life for murder, is a counselor trained in a national ministry program who sees his volunteer work as part of his own growth. (AP Photo/Andrew Welsh-Huggins)

As late-morning sun streams through narrow prison windows, convicted killer Scott Abram stands beside a fellow inmate, speaks quietly to him and starts singing “Amazing Grace.” The prisoner appears to smile, but it’s difficult to gauge his response. He is dying.

He passes away two days later in early September.

Abram is a counselor trained in a national ministry program who sees his volunteer work as part of his own growth. Behind bars since the early 1990s for murder, he has gotten used to spending time with male prison friends as they die in rooms 205 or 206 on the second floor of the state’s prison for chronically ill inmates.

“We’re all human, and we make mistakes,” said Abram, sentenced to 15 years to life. “There are some that make bigger mistakes, like me. I make a lot of mistakes each day.”

Abram, 48, is a Stephen Minister, a type of lay counselor common in churches around the country but rarer inside prison walls. He is one of 15 male and female inmates trained in the program at Franklin Medical Center, a small prison just south of downtown Columbus that houses some of the state’s sickest inmates, many of whom die there.

Abram’s hospice work is just part of his Stephen Minister counseling. He and others also work with troubled inmates, perhaps helping them write a letter or make a call.

In Ohio and nationally, the inmate population is graying. Ohio had 8,558 inmates over 50 this year, nearly double the number in 2001. Other states, including Louisiana, Iowa and California, have similar prison programs.

Prisoner Sheila Belknap says her participation also makes her think about her own mistakes. Belknap, 42, plans to continue hospice work after she is released next year from a four-year term for theft charges. She calls her work with the dying a privilege.

A prison official points out a handmade quilt featuring the names of inmates who have died in prison hospice at the Franklin Medical Center, on Friday, Sept. 11, 2015 in Columbus, Ohio. Inmates trained in a counseling program called Stephen Ministries help fellow prisoners in their last days. (AP Photo/Andrew Welsh-Huggins)

“It’s just the satisfaction I get just from being there at the time of need,” she said. “No one wants to pass alone.”

Nos. 205 and 206 — there is also a room in another unit for female patients — resemble ordinary hospital rooms. Hanging wall quilts made by volunteers soften the institutional feel. Abram and Belknap are often joined by members of a Columbus choir that sings to hospice patients around central Ohio.

The Department of Rehabilitation and Correction hopes to expand the number of Stephen Ministers at other prisons, though hospice care would remain in the Columbus facility.

On average, an Ohio inmate dies of natural causes every three and a half days, not unexpected with a statewide prisoner population of 50,000, the size of a small city.

The national Stephen Ministry office in St. Louis is unaware of other state prisons with inmates trained in their counseling program.

Louisiana began an inmate hospice program in 1997 at the state penitentiary in Angola and developed a 40-hour training program for offenders, who volunteer for four-hour shifts with dying prisoners. California says it established the nation’s first inmate hospice at the California Medical Facility in Vacaville in 1993.

Inmate Scott Abram, holding a training dog, Ziva, talks about his work counseling fellow inmates including some who are dying and spending their last days in a prison hospice program, on Friday, Sept. 11, 2015 in Columbus, Ohio. Abram, serving 15 years to life for murder, also trains puppies that may end up as pilot dogs. (AP Photo/Andrew Welsh-Huggins)

The program at the Iowa State Penitentiary in Fort Madison, Iowa, was the subject of “Prison Terminal: The Last Days of Private Jack Hall,” a documentary by filmmaker Edgar Barens that received a 2014 Academy Award nomination.

“It not only helps the prisoner who’s dying of a terminal illness, but it’s so redemptive for prisoners who go through the process of becoming hospice workers,” said Barens, a visiting media specialist at the University of Illinois at Chicago. “It’s tenfold payback when a prison does this.”

Complete Article HERE!

October 5, 2015October 5, 2015

California Governor Signs Right-to-Die Bill

By Josh Sanburn

California becomes the fifth state to allow the controversial practice

California Gov. Jerry Brown signed legislation Monday allowing doctors to prescribe life-ending medication to dying patients, making the state the fifth to legalize the practice and the first since the death of Brittany Maynard, whose decision to leave the state to end her life last year lent new urgency to the right-to-die movement.

Brown, a Catholic who at one point considered joining the priesthood, said in a statement that the religious objections to the bill were not enough to convince him to veto it.

“In the end, I was left to reflect on what I would want in the face of my own death,” Brown said in a statement explaining his decision. “I do not know what I would do if I were dying in prolonged and excruciating pain. I am certain, however, that it would be a comfort to be able to consider the options afforded by this bill.”

Right-to-die supporters have been working to legalize the practice in California for almost two decades. The movement gained significant momentum last year when Brittany Maynard, a 29-year-old newlywed, was diagnosed with terminal brain cancer and left California for Oregon to take advantage of the state’s Death With Dignity law, which went into effect in 1997. Since Maynard’s death, half of all U.S. states have introduced aid-in-dying legislation.

“This is the biggest victory for the death-with-dignity movement since Oregon passed the nation’s first law two decades ago,” said Barbara Coombs Lee, president of Compassion & Choices, a right-to-die advocacy group, in a statement.

Polls showed that three-fourths of Californians supported the measure, but legislators routinely ran into opposition from disability rights advocates who say the practice can open the door to abuses of the elderly and disabled, as well as the Catholic Church, which says only God should decide when people should die.

The law allows doctors to prescribe life-ending medication to patients who have been given six months or less to live. It requires two doctors to consent to the prescription as well as written requests from the patient for the medication. California joins Oregon, Washington, Vermont and Montana, which also allow the practice.

Complete Article HERE!

October 2, 2015

I’m not as brave as my father, who died in misery

tony lopez — When Steve Lopez’s father, Tony, died he was so ill he couldn’t care for himself and death was a release.

By Steve Lopez

Dear Gov. Brown:

Three years ago, my father died in a fairly typical manner. His heart and his body had given out, he could barely move, he couldn’t feed himself and he was in diapers.

He was in a bit of pain, but the physical suffering was nothing compared to the emotional and psychological side of things. His life was gone and there was no joy in a day. He had no privacy and he hated having to be cared for as he lay in bed helplessly, a witness to his own lingering death, which finally arrived as a friend might, delivering the gift of mercy.

Maybe I’m not as brave as my father, but I knew then that I do not want to die that way and wouldn’t want my loved ones to experience the misery of watching me slowly dissolve.

In some circumstances, death may be the best remaining friend and it is reasonable and moral to accelerate the dying process.– Dan Maguire, professor, Marquette University

So what will I do? I don’t know. I wouldn’t be one to put a gun to my head, as some do. Maybe I’d stop eating and drinking water, but that can be a pretty miserable way to go too.

Gov. Brown, I don’t know if you read about this in my column, but I died once. Just after a knee operation, I went into cardiac arrest and flat-lined. That wouldn’t be a bad way to go, actually. No long, drawn-out affair. No messy stuff. But I was resuscitated, and I’m alive and well for the time being, and I’m asking you to give dying Californians the right to depart on their own terms.

No one seems to know what you will do with the End of Life Option Act that’s in your hands and would give us the same freedom people have in Oregon, Washington and elsewhere.

I know that our democracy is based on a separation of church and state, and that leaders such as you try not to let the tenets of their faith assert undue influence on secular decisions. I know too, however, that our values are usually set early and that religious beliefs are often core to who we are.

So it seems reasonable to note that the Catholic Church opposes what critics call assisted suicide and supporters call aid in dying, yet polls suggest most Catholics — as well as most Californians — want the option of going through a series of steps to get a life-ending prescription from a physician.

I know, governor, that you got a little farther than I did in the Catholic Church. You were a seminarian and I topped out at altar boy.

I don’t know if you still identify as a Catholic, but to me, any religion is about a search for meaning and we all know you’re a thoughtful — even spiritual — man who reflects, quotes Scripture and works from a set of basic moral principles.

So I wanted to share some conversations I’ve had with religious people who came to support aid in dying in the context of their experience and training.

“As a Christian I believe God is love,” the Rev. Ignacio Castuera once told me. “…And the God of love would not want any of God’s creatures to suffer undignified situations, especially at the end of life.”

Castuera grew up Catholic and is now a United Methodist Minister in Pomona. He told me about his ministry in West Hollywood during the AIDS epidemic, and he spoke of the honor of being with those who found a way to purchase life-ending medications and face death bravely with loved ones present.

“Death,” Castuera said, “is not the final stage for humans.” It is, in his mind, a deliverance to God.

The Rev. Sergio Camacho, a Methodist minister in Montclair, shares that view.

“Over the years, I’ve seen so many people dying, from brain tumors and other diseases,” he said. “It’s unbelievable how they suffer.… Before they go, they curse their families, they curse themselves, they curse God. It’s horrible, and God doesn’t want that. He wants us to go in peace. We need to think about this with merciful hearts.”

Dr. Robert Olvera, a Catholic physician and former altar boy who grew up in East Los Angeles, has supported aid in dying since watching his daughter die, at 24, from the leukemia she lived with for 17 years. She was blinded by her disease, he said, painkillers offered no relief and she suffered greatly.

“She was basically living in a black hole,” he said. “She had no quality of life.”

She was wasting away, her face was sunken, she did not want to be seen by anyone and she was in that state for the final three months of a life that ended last year.

“She begged me to give her some sleeping pills,” said Olvera, who couldn’t answer that request, knowing he could be criminally charged and lose his license to practice medicine.

Doctors can and do offer palliative sedation, but Olvera believes they should also have the right to grant a terminal patient’s wish to die at the time of their choosing, provided they are of sound mind and have satisfied the safeguards against abuse or coercion that are written into the end-of-life legislation.

I asked Olvera how he would respond to the argument that the timing of death is not something patients and doctors should decide; that should be left in God’s hands.

Doctors, he said, can unplug ventilators and they can answer a patient’s wish to be taken off dialysis. They can recognize that modern medicine has advanced to the point where people can be kept alive almost indefinitely, but all of us must ask whether, in some cases, we are extending life or prolonging death.

As both a physician and a Catholic, Olvera said, he believes no one should have to experience what his daughter did.

I understand that your education was Jesuit, Gov. Brown.

Well, Dan Maguire studied in Rome, became a Jesuit priest and now teaches moral theology at Marquette University, a Jesuit school. Here’s what he told me:

“For almost 50 years a number of Catholic theologians have taught that for the terminally ill, ending life may, at times, be the best that life offers. In some circumstances, death may be the best remaining friend and it is reasonable and moral to accelerate the dying process.”

According to Scripture, Maguire told me, we are made in the image and likeness of God, and it is our God-given right to decide for ourselves on matters such as aid in dying.

“Thomas Aquinas says with great wisdom that human actions are good or bad depending on the circumstances,” Maguire said. “In certain cases, you could say that life is good, and always to be served as best you can, but there are times when the ending of life is the best that life offers, and moral beings can make that decision for themselves…. That’s what human freedom means.”

It’s true, Gov. Brown, that some fear the life-ending option will be abused, and that those who are disabled or in a state of depression will choose inappropriately or be manipulated by relatives who stand to benefit financially.

It’s true, as well, that we need to be mindful of the potentially dangerous intersection of end-of-life options and cost-cutting by health insurance companies that have a financial disincentive in costly end-of-life procedures going on for long.

But I believe the legislation before you offers safeguards against abuses.

I don’t know if my father — who refused a feeding tube before his life came to a close — would have taken advantage of the End of Life Option Act, had it been available at the time.

I’m certain many people — probably most people — would want no part of it. That’s their choice and they should be entitled to the finest palliative care.

But I know that since writing about his death, I have heard from hundreds of Californians who would take a small measure of comfort in knowing that if they so choose, they can avoid physical or emotional suffering as the inevitable end nears. They believe that, as Dan Maguire put it, there comes a time when death is a friend.

I stand with them.

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