I went from being a labor-and-delivery nurse to a death doula.

I help people who want to die on their own terms by refusing food and water.

People who voluntarily stop eating and drinking tend to be terminally ill people whose doctors can’t predict how long they have left to live.

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  • Nancy Simmers is a death doula whose clients decide to end their lives by refusing food and drink.
  • A former labor-and-delivery nurse, Simmers says the process of death is similar to birth.
  • This is Simmers’ story, as told to Jane Ridley.

This as-told-to essay is based on a conversation with Nancy Simmers. It has been edited for length and clarity.

Most people are taken aback when they hear that I’m a death doula. They’re shocked when I say that I work exclusively with people who want to die on their own terms, by voluntarily stopping eating and drinking.

The method, known as VSED, might seem terrible at first. But it lets you take control of the circumstances of your death.

Most people support the idea of the power of the individual. They understand someone who says, “It’s my life, let me get on with it.” But they feel uncomfortable when someone says the same thing about their death.

I used to be a labor-and-delivery nurse. Over the years, I’ve come to see death and birth as physical, emotional, and spiritual thresholds. They are similar processes. They involve uncertainty, fear of the unknown, and transformation. Both require courage, surrender, release, compassion, and support from others.

Some people reach a point in their life and decide they’re done

The US law largely doesn’t prevent people from choosing to end their life by VSED, which doesn’t require permission from a physician.

Many people who opt for VSED have a terminal illness. But it’s almost impossible to get a firm prognosis for neurological diseases such as ALS and Parkinson’s. People can suffer for years as their bodies and mental capacities deteriorate. Some people reach a certain point and say, “I’m done.” A person in their 90s who has lost their vision, hearing, and bladder control may feel that their quality of life is nil.

A headshot of death doula Nancy Simmers
Nancy Simmers, a death doula, helps people who opt to stop eating and drinking, a method of death known as VSED.

If a doctor won’t certify that you have less than six months to live, you are not eligible for “death with dignity.” The laws — which apply in eight states and Washington, DC — allow people to take lethal drugs under medical supervision.

VSED is another version of death with dignity. Each VSED death I’ve attended has been different, but not undignified. Most of my clients die in their own homes surrounded by their loved ones. It’s a gift. It wasn’t VSED, but when my father was dying of cancer in 1991, my sons — 8 and 5 — were in and out of their grandpa’s room. It doesn’t do anybody any favors to be frightened of death.

VSED requires a lot of planning

A lot of people know nothing — or very little —about VSED. There are some scary myths. People think that it involves great suffering and that it goes on indefinitely. They assume it will affect your life-insurance policy.

VSED is not to be considered lightly. It needs lots of careful planning. It’s reversible up to a point, and there are medications to ease the transition. Family members usually know about the decision and agree that it’s the choice of the individual concerned. Life insurance is mostly straightforward because the doctor does not write “suicide” as the cause of death; they note the person’s underlying condition, such as cancer.

An altar full of photos that pays tribute to the person dying
Simmers set up an altar to celebrate the life of a woman who chose VSED.

People considering VSED in my home county of Whatcom, Washington, find me via word of mouth or online. I’ll arrange to meet with them and their family. My partner, Andrea Fenwick, and I give frank and honest answers. There’s no sugarcoating. We’re part of the nonprofit VSED Resources Northwest, though we advise people across the world.

We can understand why families question their loved one’s decisions. It depends on the case, but we might tell them: “This is your beloved person, and your beloved person is suffering. It’s their body and their choice.”

We’ll tell the family, “Although you will suffer because you’ll miss this person, it’s their choice to end their suffering — how can you be supportive of this choice?”

Once things are decided, we mark the start date with a little ceremony. We celebrate the person and their life and their choice. We thank them and shower them with love and gratitude.

Many families make a small altar. It’s the focal point of their room. They’ll decorate it with family photos and precious items that remind the loved one and their visitors about their interests and skills. It’s a reflection of a life well lived.

I like to light a candle, symbolizing the person as a spirit. After the death, it becomes part of a leave-taking ceremony and is blown out.

VSED is a serious commitment, but it doesn’t have to be a solemn affair. My last client lightened things up with a touch of humor. We’d ask how she was feeling during her first few days of VSED — she joked about wanting a cold Pepsi.

I tell my folks that dying has been around for millions of years. Your body knows what to do. Just trust your body. Our bodies know how to breathe. Our bodies know how to process food. Our bodies know how to birth. They know how to die.

It can be hard for families to watch as their loved one becomes confused because of dehydration

VSED takes an average of nine to 11 days. The person is usually up and about for the first few days. But the middle stage, which can last almost a week, is the marathon.

They’ll need medication — a mixture of morphine and anxiety drugs — to help them through the confusion and delirium caused by dehydration. It’s hard for the family to watch. A designated person will step in if the loved one calls for food or water.

The final stage lasts about three days. Dehydration makes people sleepy. It’s reassuring for everyone because you lose consciousness when your body goes into crisis mode.

The lack of fluids affects your kidneys and liver. The excess bilirubin makes the skin look yellow. The feet and the fingertips turn blue. Breathing becomes shallow or agonal.

Friends and relatives gather at the bedside to say goodbye. It reminds me of families coming together to welcome a newborn. We want the very best for the baby; we support them when their journey in life begins. People deserve the same support when the journey ends.

Complete Article HERE!

What Happens When an Animal Dies at the National Zoo?

Dealing with death is part of the job.

Luke, the African Lion, who died on Oct. 19.

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With roughly 2,000 animals in the care of the National Zoo, dealing with the end of life is an inevitable part of the job, and these last few months saw several notable deaths.

Luke, a 17-year-old African lion, died on Oct. 19; Naba, an 18-year-old African lion, died on Sept. 26; and Calli, a 17-year-old California sea lion, died on Sept. 7. While counts obviously ebb and flow year by year, the zoo (using data from the past three years and including small animals like fish) estimates that it loses about 200 animals annually.

But while we get to see how the critters celebrate their birthdays and even holidays (hint: it often involves elaborate species-friendly treats), their deaths are more of a mystery. Is there a funeral? A secret animal graveyard somewhere?

Well, no and no.

While zookeepers are human and certainly mourn the loss of their “coworkers”—the zoo even maintains a relationship with a local animal grief counselor—they are also biologists. And in death, there’s a window for research.

Consequently, just about every animal that dies in the care of the zoo, whether from euthanasia or on its own, is immediately sent to the zoo’s pathology lab for a necropsy—the equivalent of a human autopsy.

“All organs are evaluated, all joints are evaluated, diagnostic samples are taken, maybe even beyond what we took when the animal was alive,” says Don Neiffer, chief veterinarian for the National Zoo. “The samples are then frozen for future evaluation and research that could benefit conservation. Tissues also go out for something called histopathology,” or the microscopic study of disease.

According to Neiffer, the zoo has tissue samples of nearly every animal there since the ’70s—including a few species that are now extinct.

Any resulting information is then shared across the industry, providing useful data to researchers who may be studying a niche health issue within a certain species that they normally wouldn’t have access to. “In death, we utilize these animals to help improve the lives for the others they left behind,” says Neiffer.

For example, when the first baby Asian elephant born at the zoo unexpectedly died in 1995, its necropsy led to the discovery of a previously unidentified herpesvirus in elephants. “Basically, it was the wellspring for elephant herpes virus research, diagnostics, treatment, and hopefully an eventual cure,” says Neiffer.

Veterinary technician Hannah Sylvester works with elephant blood samples, extracting DNA, as part of elephant herpesviruses research.

Even local wildlife, like squirrels that wander onto the zoo’s campus and die, undergo necropsies.

“Because of our collection, we want to do surveillance,” said Neiffer. “If [dead wildlife] comes to us, we do at least minimal gross dissection, but oftentimes we do diagnostics. We’re looking at any issues that could concern our team or animals,” such as rabies or Avian influenza. Likewise, the zoo shares this data with local wildlife departments.

Afterward, leftover parts of the animal—think a shell from a tortoise or the skeleton of a cheetah—might go to a museum or education center. In fact, the National Museum of Natural History has several skeletons from the zoo in its collection.

Anything remaining will be cremated, including even the tiniest of animals. “Everything from guppies to elephants is incinerated,” says Neiffer.

While burials were once commonplace at zoos, very few bury their animals anymore. One reason for that: “You don’t want illicit wildlife parts ending up in anybody’s hands,” says Neiffer.

Of course, underlying all these scientific processes is the emotional side of death, too. “Anyone who has a good understanding of how much we love these animals and care for them can understand how difficult end of life care is,” says Brandie Smith, the zoo’s director. “But also, these are professionals. These are people who train their entire career to do this.”

With so many of the animals living past their species’ mortality rates in the wild, the zoo’s workers must regularly confront a heart-wrenching question: if and when to euthanize a terminally ill animal. The zoo keeps a detailed chart, tracking the animal’s quality of life‚ marking whether it’s still eating, staying active, and socializing. When it becomes clear that the “animal is suffering beyond what’s reasonable,” then it’s time.

“It’s hard on us, but we take on that burden as zookeepers,” says Neiffer. “It’s our onus and our responsibility to provide the animals with that peaceful passage to the next plane. When we can remove [their suffering], we’ve given them that last gift.”

Still, it’s always hard to say goodbye, which is why the zoo provides its keepers a final moment with the animal before euthanasia. Even particularly social species, like elephants and great apes, receive a moment to acknowledge the death of their habitat mate (assuming it died from a noninfectious cause). 

While there’s ultimately no funeral or ceremony, there are sympathy cards. The public often sends in memories they had of an animal, drawings from children, and well wishes for staff, says Smith. In the case of a panda cub that lived only for a few days, Smith says “the outpouring of sympathy and grief from the public was really powerful.”

Then, as with all things, life goes on.

“Animal keepers as a whole are an incredibly stoic group of people and they’re good at grieving with one another—but they also have a job to do,” says Smith. “There are other animals to take care of. It’s part of the cycle they have been trained for.”

Complete Article HERE!

Dia de los Muertos (Day Of The Dead) 2022

More than 500 years ago, when the Spanish Conquistadors landed in what is now Mexico, they encountered natives practicing a ritual that seemed to mock death.

It was a ritual the indigenous people had been practicing at least 3,000 years. A ritual the Spaniards would try unsuccessfully to eradicate.

A ritual known today as Dia de los Muertos, or Day of the Dead.

The ritual is celebrated in Mexico and certain parts of the United States. Although the ritual has since been merged with Catholic theology, it still maintains the basic principles of the Aztec ritual, such as the use of skulls.

Today, people don wooden skull masks called calacas and dance in honor of their deceased relatives. The wooden skulls are also placed on altars that are dedicated to the dead. Sugar skulls, made with the names of the dead person on the forehead, are eaten by a relative or friend, according to Mary J. Adrade, who has written three books on the ritual.

The Aztecs and other Meso-American civilizations kept skulls as trophies and displayed them during the ritual. The skulls were used to symbolize death and rebirth.

The skulls were used to honor the dead, whom the Aztecs and other Meso-American civilizations believed came back to visit during the monthlong ritual.

Unlike the Spaniards, who viewed death as the end of life, the natives viewed it as the continuation of life. Instead of fearing death, they embraced it. To them, life was a dream and only in death did they become truly awake.

“The pre-Hispanic people honored duality as being dynamic,” said Christina Gonzalez, senior lecturer on Hispanic issues at Arizona State University. “They didn’t separate death from pain, wealth from poverty like they did in Western cultures.”

However, the Spaniards considered the ritual to be sacrilegious. They perceived the indigenous people to be barbaric and pagan.

In their attempts to convert them to Catholicism, the Spaniards tried to kill the ritual.

But like the old Aztec spirits, the ritual refused to die.

To make the ritual more Christian, the Spaniards moved it so it coincided with All Saints’ Day and All Souls’ Day (Nov. 1 and 2), which is when it is celebrated today.

Previously it fell on the ninth month of the Aztec Solar Calendar, approximately the beginning of August, and was celebrated for the entire month. Festivities were presided over by the goddess Mictecacihuatl. The goddess, known as “Lady of the Dead,” was believed to have died at birth, Andrade said.

Today, Day of the Dead is celebrated in Mexico and in certain parts of the United States and Central America.

“It’s celebrated different depending on where you go,” Gonzalez said.

In rural Mexico, people visit the cemetery where their loved ones are buried. They decorate gravesites with marigold flowers and candles. They bring toys for dead children and bottles of tequila to adults. They sit on picnic blankets next to gravesites and eat the favorite food of their loved ones.

In Guadalupe, the ritual is celebrated much like it is in rural Mexico.

“Here the people spend the day in the cemetery,” said Esther Cota, the parish secretary at the Our Lady of Guadalupe Church. “The graves are decorated real pretty by the people.”

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The hardest word

— Study finds doctors, families avoid saying ‘death’

By Paul John Scott

A new study has found that conversations between families and physicians who treat critically ill infants avoided direct language in 92% of all references to death and dying, but that the two parties did so through different linguistic evasions.

The study, conducted by Duke University researchers between September 2018 and 2020, analyzed 68 recorded conversations between physicians and 24 participating families of infants hospitalized for neurologic conditions in an intensive care unit.

It was published in the journal JAMA Network Open.

“This study was really inspired by a recognition that it can be hard to talk clearly and directly about challenging, high-stakes topics,” said Dr. Monica Lemmon, an associate professor of pediatrics and population health sciences at Duke and lead author of the paper. “We aimed primarily to characterize the way death is discussed.”

While it is commonplace to use softer language for death and dying in day-to-day conversations, in order to minimize confusion, consensus guidelines within medicine the paper noted “emphasize the importance of clear communication, including avoiding euphemism use.”

In the new study, researchers found 33 out of 68, or 45% of all family meetings, involved a discussion of death. There were 406 recorded references to death within those meetings — 275 made by clinicians, and 131 made by family members. Of those, the words “die,” “death,” “dying” and “stillborn” were used just 15% of the time by family members, and 5% of the time by physicians.

“What was most striking was the direct use of the words themselves … were used quite rarely,” Lemmon said. She said that “families often used colloquialisms or common phrases to reference death,” while “clinicians instead most often used medical jargon, which may be less clear to people who aren’t medically trained.”

Physicians used medical jargon 43% of the time when discussing death during the study, which included as examples terms for death such as “event,” “code,” “episode,” “arrest,” or “irretrievable drop” in heart rate.

Families preferred colloquialisms 34% of the time, the paper found. These included phrases such as “pass away,” and “not make it.” The paper identified two other forms of euphemisms: expressions referring to survival — like “don’t live,” or “not survive” — and the use of pronouns in place of death, such as “it,” “this,” “that” or “something.”

In an accompanying commentary, a trio of pediatricians from the University of Minnesota Medical School placed the findings within a larger problem described as “jargon oblivion” in medicine. For lead author Dr. Michael Pitt, the new study provides physicians with a framework to better understand what that looks like in practice.

“I think what this study adds is actual proof to what we expected,” he said. “Which is that we tend to avoid these difficult words — death, dying — at the bedside during important conversations with families. They elegantly quantified that in a study where they recorded and transcribed these transcripts, and showed that providers rarely used these terms.”

The harm, Pitt says, is that families may need to hear the word death to understand that death is what is being discussed.

“They hear ‘we did everything we could’ (and) they might want to reply, ‘OK, get somebody else to do something, then.'”

Pitt recalls that when his father recently died, “the nurse called my mom and said, ‘He’s no longer with us,'” he said.

“She initially thought that meant that he’d been transferred, or gotten lost … you’re having the most serious conversation of a family’s life, yet they may not understand what you’re saying unless you use clearer language.”

Dr. Brenda Schiltz is a pediatric critical care specialist at Mayo Clinic who has had numerous conversations with families in which she was required to discuss the actual or possible death of a child. “I think it’s a good paper,” she says of the Duke study.

“It wasn’t surprising at all, to be honest,” she adds. “We teach trainees all the time about when we’re breaking bad news … to be very concrete, to use the word ‘death.’ But even when do all those teachings, it’s a hard thing to tell somebody. It’s a very hard thing to tell somebody.”

Schiltz says that while clear communication about death is critical, it often is a shift in thinking for physicians.

“Not only is it hard,” she said, “as a physician and everybody that’s on the medical team, we’re trying to save these babies. No one wants to feel as if we lost that battle. We’re always fighting. We’re always trying to keep hope alive, and try one more thing … It’s tough to admit when, despite our best efforts, we can’t save somebody.”

The study did not look at whether the families studied preferred direct language about death, Lemmon notes, or whether the euphemisms identified produced any confusion in the conversations.

“Some euphemisms might be quite clear to all the parties involved,” she said. “Especially when they’re used by a family member and mutually understood by the clinical team. That said, it’s important there’s a shared understanding of what we’re all talking about, and for this particular study, the outcome of death is something critically important for everyone to be on the same page around.”

Complete Article HERE!

How These 5 Death Rituals From Around The World Honor The Dead

— From finger amputations to blindfolded funerals, people have found some creative ways to say goodbye to their loved ones.

By Donna Sarkar

Grief often accompanies the loss of someone close and can be a difficult process.

“When an individual passes away, they leave a hole not only in our hearts but also in our social networks, in our family lives, in our village, or town or community,” says Shannon Lee Dawdy, professor of anthropology at the University of Chicago.

But what can we do with this gaping hole? For many, hosting a funeral or participating in a death ritual to say goodbye to the deceased channels this grief. Funeral rituals allow people to come together and not only acknowledge their loss, but also come to an understanding of how to go on and re-weave the social fabric, explains Dawdy. Death rituals are much more than just for healing individually; they also allow different communities to unite and fix rips or tears in their social fabric in their own ways, she says.

Cultures around the world have a distinct set of beliefs that guide their funeral rituals. Let’s take a closer look at five unique traditions that celebrate and honor the departed.

1. Endocannibalism: Feasting With the Dead

The earliest instances of cannibalism date back to over 800,000 years in Spain’s Atapuerca Mountains. Anthropologists think early hominids likely used it as a territorial defense strategy. But today, anthropologists find cannibalism is used for more than just survival purposes.

The Wari people of Brazil and the Fore tribe in Papua New Guinea are two examples of tribes that consume deceased community members as a religious or cultural practice. Feasting on the dead is a way for the Wari tribe to socially mourn. They believe the funeral rites allow their ancestors to transform from humans to spirits, and the feast allows an individual to release painful memories that can linger after a loved one’s death.

For the Fore tribe, the cannibalistic tradition calls on women and children to consume the flesh of Fore members. Everything except the gallbladder is removed from the dead body. The remains are mixed in with ferns and cooked in tubes of bamboo that women and children both prepare and consume. While the act is viewed as a symbol of love and grief mixed together, medical researchers have discovered that many Fore tribe members may be victims of a fatal degenerative disease called kuru due to their cannibalistic practices.

2. Finger Amputations

For the women of the Dani tribe in Papua New Guinea, cutting off the top of their finger in a funeral ritual to mourn the loss of a family member or loved one is a cultural norm.

While it’s unclear why the ritual mainly involves women, the ritual, called Ikipalin, is a way for women to physically display their grief. The practice involves tying a string tightly around the upper part of a finger for 30 minutes. This allows the finger to become numb and prepares it for removal. Then, an ax is used to remove the upper half of the finger and the open wound is cauterized, to avoid further bleeding and infection.

The ritual is rooted in religious beliefs that suggest finger-cutting can ward off the deceased person’s restless spirit. Though the Indonesian government recently banned the practice for all tribe members, the aftereffects of the mourning ritual can still be seen on the hands of many older women of the tribe.

3. A Blindfolded Funeral

In the Philippines, blindfolds are not for the mourners, but for the deceased Indigenous people of Benguet. And because of the diversity found in the Philippines’ regions, this is just one of many unique burial rituals. In this practice, the blindfold protects the deceased from the suffering world.

The deceased are cleaned, blindfolded and tied to a chair, which is then placed in the main entrance of a home. The hands and legs are tied together to keep the body in a sitting position for eight consecutive days.

During those eight days, the elders perform a bangil rite, which involves the reading of a biographical chant of the deceased. The mourners also strike bamboo sticks together to ensure that their loved one reaches heaven. The reason why the deceased sits in a chair is so that when they are removed, they can rest in the fetal position.

4. Hanging Coffins

Though the funeral practice of hanging coffins dates to over 2,000 years ago, the Igorot people of the Philippines still practice this ancient burial custom today.

For the tradition, one carves out their own coffin from hollowed logs. The coffins have various intricate designs that represent fertility and longevity. Upon death, the deceased are placed inside their coffins and then hung off the side of a cliff or cave.

The height of the hanging coffin represents the status of the individual. Typically, male community leaders or distinguished members of society are placed higher on the cliff. According to the community’s beliefs, the higher the dead are placed, the greater their chances are of reaching a higher position in the afterlife.

Today, the hanging coffins can primarily be found in the town of Sagada, though many have deteriorated and even fallen over time. Various cultures in China and Indonesia have also practiced hanging coffins.

5. Death Beads

A shortage of burial space encourages a new funeral practice in South Korea. People are transforming a loved one’s ashes into shiny colorful beads. “Death beads” have been growing in popularity since the early 2000s as a way to honor and keep the deceased nearby. A law passed in 2000 now requires anyone in South Korea burying the dead to remove the grave 60 years after burial, which could influence the new practice.

Bonhyang, the death bead company founded by Bae Jae-yul, features beads that range from blue-green to pink, purple and black in color. Ultrahigh temperatures melt and crystallize cremated ashes that are stored in shiny beads, and the process takes just 90 minutes. Instead of wearing the colorful beads as jewelry, many opt to display them inside glass containers in their homes, where they are accessible to the whole family.

Complete Article HERE!

Can we choose the moment we die?

— So many stories of dying people holding on until a loved one reaches the bedside or leaves the room make some think we may have some control over when we pass away

by Eve Glicksman

The man had promised his betrothed daughter he would walk her down the aisle. So, at the recommendation of the doctor treating him for advanced lung cancer, the wedding date was moved up by two months.

“He was a man of his word,” says Charles von Gunten, the oncologist treating him. It took enormous energy for his bed-bound patient to dress for the occasion, held in a hospice facility, and accompany his daughter down the aisle in a wheelchair, von Gunten says.

That evening, after the reception, the father of the bride died.

You may have heard a version of this story before. A parent hangs on to life until a child arrives. Or against all medical odds, someone lives to see the birth of a grandchild. Or family members sit by the bedside for two days and the loved one dies when they step out for lunch.

Can people choose the moment they die?

Lizzy Miles, a hospice social worker in Columbus, Ohio, sees it all the time. Miles’s own great aunt died “the very second her chaplain walked in the room,” she said. Her great aunt, of strong faith, had been nonresponsive and inexplicably alive for days. In hindsight, the family believes she was waiting for the chaplain.

“All these things happen [often] enough that those who work in the field aren’t surprised,” says von Gunten, a pioneer of palliative medicine in the 1990s and editor in chief of the Journal of Palliative Medicine.

One theory is that a hormonal stimulus may enable us to hang on until a special event or loved one’s arrival. “What people will do for one another in the name of love is extraordinary,” von Gunten says. “I think of it as a gift when it happens.”

But there are limits. To be clear, no scientific evidence exists that we can control the moment we die. If we could will our death, there would be no right-to-die movement or legal battles over euthanasia.

‘Just done living’

Felice LePar, an oncologist with Alliance Cancer Specialists in the Philadelphia area, also believes that people may have some sway over the timing of their death. LePar cautions families that patients sometimes die quickly after deciding on hospice; this, despite no change in their medical condition.

“We can’t fully understand it,” she says. “Some people decide that they are just done living.” Other times, when reviewing lab tests, she wonders how a patient can still be alive.

“My rule of thumb is that when someone says ‘I think it’s soon,’ I listen,” von Gunten says. “They tend to know more than I do” about when they’re dying.

Few scientific studies have explored our last moments of life. Protectiveness and respect for the deceased figure into that. Dying is seen as sacred across all cultures and getting approval from ethical review boards for such studies is difficult, von Gunten says.

Questions about potential harm to participants and intrusiveness arise, Miles add. “Do we bother people while they’re dying to ask questions?” she says. “This is a tender moment for people.”

Sociologist Glenys Caswell in Nottinghamshire, England, a self-described death studies scholar, has studied people who have died alone and stresses that it is not always sad.

“We all want different things in dying as we do in our living,” Caswell says. “Some [who are dying] don’t want people fussing over them or want to be alone when they aren’t feeling well. Others don’t want to distress their family.”

The hospice-at-home nurses whom Caswell interviewed during her research believe we have some measure of control over death after watching many patients die after loved ones left the room. “Hearing voices may be what was holding them on to life,” Caswell says. When the family leaves, they are able to relax and let go, she says.

Protective gesture

Waiting to die until people leave the bedside can be a protective gesture to spare loved ones who might not cope well, Miles says.

“It seems to happen most often when the patient is a parent,” she writes in one of her Pallimed blog posts. Her mother died when Miles took a short break to shower. The social worker says she felt guilty about that for years but learned to respect what seemed like her mother’s choice and personality. “Don’t project your own beliefs about what makes a good death,” Miles says she advises others who experience this.

LePar says people with a terminal illness often think more about the people they are leaving behind than about themselves. They do what they think their family wants, she says, and do not want to be a burden.

That’s why standard advice often includes giving permission to a loved one to die. “That reassurance can help people on both sides let go in peace,” von Gunten says.

“ ‘You’ve done what you need to do. We’re all right,’ ” Caswell suggests as an example of what to say.

Miles sees it differently, however: “If it is fear that is keeping a patient lingering, telling them it’s okay to let go may put unnecessary pressure on them to go before they are ready.”

An awareness of surroundings, people

How much do people in a nonresponsive state know about what’s going on around them? Researchers used electroencephalography to measure the brain response of dying hospice patients to voices and sounds, before and after they lost consciousness.

The study found evidence of the brain responding to sound stimuli, supporting the idea that patients may know when someone is in the room. The researchers could not confirm, however, whether the patients understood what they were hearing or were able to identify voices.

Hospice workers refrain from saying people are “unconscious,” preferring the term “nonresponsive,” Miles writes on her blog. Even actively dying patients seem to have an awareness of what’s going on in the room, she says. Minute gestures — the fluttering of an eye, a swallow or a head turn — can be a response. One patient started breathing along with the music she put on, “almost like he was conducting,” she recalls.

I am convinced my father could hear me while dying despite his deep-sleep appearance. He squeezed my hand once and there was an upward head tilt when I said I’d take care of my mother. Then, a funny, bemused lift of the brow when I said I would write about him.

More convincingly, I had been updating my father regularly on my brother and sister-in-law’s journey to be there as I received word in texts — the flight delay, rental car line, traffic. Within 15 minutes of my brother’s arrival, my father died after holding on, nonresponsive, for 16 hours.

Death is not well-understood

“It’s impossible to know, let alone prove or disprove,” says Sam Parnia, about whether we can influence our time of death. Parnia is an expert in the scientific study of cardiac arrest and death and associate professor of critical care medicine at New York University Grossman School of Medicine.

What Parnia is sure about from his research is that death is not a fixed moment and that it is not well understood. Parnia has studied thousands of testimonies from people who were resuscitated after being considered dead. They consistently described feeling conscious, lucid and aware of what was going on after their heart stopped.

“Calling the time of death when the heart stops beating and the body and brain stop functioning reflects social convention rather than the science of what is happening to the body biologically,” Parnia says. “Studies have shown categorically that our brain cells do not die for many hours after we die.”

Von Gunten advises people to behave around the dying the same as always — not being afraid they will break if you hold them, for example.

“You don’t have to keep children quiet and lights don’t have to be dimmed,” he says. “Whispering outside the door is the worst thing you can do if that person always wants to know everything.”

Ideally, the dying person will have talked to family and friends about their end-of-life wishes beforehand, Caswell says. Who do you want at your bedside, or do you prefer solitude? Do you want to listen to a cherished symphony during your last hours or have someone read a favorite poem? It’s a hard conversation to have but everyone benefits from that openness, Caswell says.

Dying is the last thing you do in life. Why shouldn’t it be exactly as you want it, and maybe even the moment you want it.

Complete Article HERE!

What ‘old age’ actually means as a cause of death

By Gabriella Ferlita

The Queen’s cause of death has been announced, and people are now wondering what it really means.

After spending more than 70 years on the throne and dying at age 96, the cause of the Queen’s passing has recently been announced as that of ‘old age’.

While it’s very common to hear that somebody has died ‘of old age’, the phenomenon in itself is extremely rare from a medical perspective.

While we often mean that an older person has died of complications attributed to their age, like pneumonia, or as a result of a heart attack, it should only be provided as the sole cause of death in ‘very limited circumstances’ by a coroner on somebody’s death certificate.

The Queen’s cause of death has officially been announced. Credit: Graham Hunt / Alamy Stock Photo
The Queen’s cause of death has officially been announced.

Ageing, in itself, cannot cause somebody to die. There is, however, a condition called ‘Geriatric failure to thrive’, which medical professionals have studied which ‘describes a state of decline’ in older patients who may experience ‘weight loss, decreased appetite, poor nutrition, and inactivity.’

According to GP notebook, there are few situations in which ‘old age’ can be penned as somebody’s cause of death by a medical professional – including having ‘personally caring for the deceased over a long period (years, or many months)’ and ‘observing a gradual decline in your patient’s general health and function.’

Other situations which would allow such a prognosis includes a lack of awareness around ‘any identifiable disease or injury that contributed to the death’, and being ‘certain that there is no reason that the death should be reported to the coroner’.

'Old age' is rarely used as a cause of death on a medical certificate. Credit: Unsplash
‘Old age’ is rarely used as a cause of death on a medical certificate.

They also add: “It is unlikely that patients would be admitted to an acute hospital if they had no apparent disease or injury.”

Doctors are also advised to also mention ‘as appropriate, any medical or surgical conditions that may have contributed to the death’ alongside ‘old age’.

Doctors are also advised to also mention ‘as appropriate, any medical or surgical conditions that may have contributed to the death’ alongside ‘old age’.

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