Category: Death Curiosities

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Dying virtually

– Pandemic drives medically assisted deaths online

The late Youssef Cohen moved from New York to Oregon in 2016 because of its aid-in-dying law. During the pandemic, assisted dying for terminal patients has gone online.

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The coronavirus has stripped many of a say in the manner and timing of their own deaths, but for some terminally ill people wishing to die, a workaround exists. Medically assisted deaths in America are increasingly taking place online, from the initial doctor’s visit to the ingestion of life-ending medications.

Assisted dying laws allow terminally ill, mentally competent patients in 10 U.S. jurisdictions to hasten the end of their life. Waiting periods of 15 to 20 days mean that patients with acute COVID-19 won’t likely meet the requirements of these laws.

But the move to digitally assisted deaths during the pandemic has enabled other qualified patients to continue to exercise the right to die. While telemedicine is helping some people die on their own terms, it also makes the process harder on family members, who must now take a more active role in their loved one’s final act.

Assisted dying in America

I have spent the last four years studying assisted dying in America, particularly in Oregon and Washington, which have the country’s longest-standing assisted dying laws. California, Colorado, the District of Columbia, Hawaii, Maine, Montana, New Jersey and Vermont also allow medical assistance in dying.

A quirk in these laws has enabled the process to go virtual. While extremely restrictive in most ways, U.S. assisted dying laws don’t require a physician or other health care provider to be present at an assisted death.

Assisted dying laws require two doctors to independently evaluate a patient’s request for medical assistance in dying. But patients must be physically able to ingest the life-ending medication themselves, a safeguard that ensures they are acting voluntarily.

In Canada, by contrast, clinicians typically administer the lethal dose through an injection. Normally that’s a faster, safer and more effective method. But COVID-19 concerns are compelling some Canadian providers to suspend assisted deaths.

Attending to the dying

Though U.S. physicians aren’t required to attend an assisted death, many patients and their families do have help. In 2019, according to the Oregon Health Authority, 57% of all assisted deaths in Oregon were attended by a physician, another health care provider or a volunteer.

Trained volunteers – many of them former nurses, social workers and behavioral health experts – are critical in helping patients navigate the tricky path toward an assisted death. They know which physicians are willing to see aid-in-dying patients and which pharmacies stock the necessary medications.

In the United States, doctors prescribe a compound of four drugs – digoxin, diazepam, morphine and amitriptyline – to be mixed with water or juice. Within minutes of drinking the cocktail, the patient falls asleep, the sleep progresses to a coma, and eventually the patient’s heart stops.

Volunteers help mix the medication and supervise the ingestion, allowing families to be emotionally present with a dying loved one.

Now, because of the coronavirus, volunteers are accompanying patients and families over Zoom, and physicians complete their evaluations through telemedicine, based on recommendations released by the American Clinicians Academy on Medical Aid in Dying in March 2020.

Telehealth – a health care solution long used in remote areas – has become a critical tool of the COVID-19 pandemic. But some aid-in-dying physicians have drawn on telemedicine to reach far-flung patients for years.

“My patients love telemedicine,” Dr. Carol Parrot, a physician who lives on an island in Washington, told me during a Skype interview in 2018. “They love that they don’t have to get dressed. They don’t have to get into a car and drive 25 miles and meet a new doctor and sit in a waiting room.”

Parrot says she sees 90% of her patients online, visually examining a patient’s symptoms, mobility, affect and breathing.

“I can get a great deal of information for how close a patient is to death from a Skype visit,” Parrot explained. “I don’t feel badly at all that I don’t have a stethoscope on their chest.”

After the initial visit, whether in person or online, aid-in-dying physicians carefully collate their prognosis with the patient’s prior medical records and lab tests. Some also consult the patient’s primary physician.

‘Tough and tender situations’

The pivot to telemedicine hasn’t significantly changed that process. But patient advocacy organizations and physicians say the pandemic has amplified existing problems of access to assisted dying.

“These are tough and tender situations even without COVID,” said Judy Kinney, executive director of the volunteer organization End of Life Washington, via email.

Invariably, some terminally ill patients who wish to die face barriers. Some assisted living and nursing facilities have policies against assisted dying for religious reasons.

During the pandemic, residents in these institutions who lack access to a digital device – or the skills to videoconference with a doctor – may not be able to qualify for the law, according to Dr. Tony Daniels, a prescribing physician from Portland.

Meanwhile, a family member who objects to assisted dying may more easily undercut the process when a volunteer isn’t there in person to make sure a patient’s final wishes are carried out.

Facilitating death

Dying via telemedicine can be hard even on family members who stand behind their loved one’s decision, my research finds. Without a volunteer or physician present, families must assume a more active role in the dying process.

That includes mixing the life-ending medications themselves. Pre-pandemic, many families told me that preparing the lethal cocktail would make them feel like they were facilitating – and not just morally supporting – a loved one’s death. They were glad to outsource this delicate task.

Now they don’t have that choice.

Yet the option to assist in a loved one’s final act may be a comfort in this pandemic. It allows dying people to choose the manner and timing of their own death – and ensures they won’t be alone.

Complete Article ↪HERE↩!

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Dying old, dying young

– death and ageism in the times of Greek myth and coronavirus

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The loss of life from the spread of coronavirus has been on an enormous scale. In the USA more Americans have now died from COVID-19 than in the entire Vietnam war.

Notwithstanding some poignant and passionate speeches by particular individuals (notably New York Governor Andrew Cuomo), much of the discourse has focused on the economic, political and policy division, rather than grief for the victims.

This broadly sanguine response might be due to perceptions that it is mostly older people dying from coronavirus, although experts warn younger people can die too. Witness the relief at new reports that children under 10 have not accounted for a single transmission of the virus. The deaths of older people have been comparatively discounted, not the least because many were socially isolated even before the pandemic.

The Greeks of antiquity reflected on the death of the young and the old in some very creative mythical narratives. Greek myth reflects on and reminds us of some of the less attractive characteristics of human life and society, such as sickness, old age, death and war. In the ancient Greek world this made it harder to put old age and death into a corner and forget about it, which we tend to do.

Choosing when

Achilles, the hero of Homer’s Iliad, actually has a choice in the timing of his life and death.

He can have a long life without heroic glory, back on the farm, or he can have a short life with undying fame and renown from his fighting at Troy. The fact that he chooses the latter makes him different from ordinary people like us.

Achilles’ heroism is fundamentally linked to his own personal choice of an early death. But it also means his desperate mother, the goddess Thetis, will have to mourn him eternally after seeing him for such a short time in life. Such is the pain for the loss of a child in war.

A play by the master Athenian dramatist Euripides is even more focused on young and old death. The play Alcestis was produced in Athens in 438 BC, making it the earliest surviving Euripidean play (about ten years before the plague at Athens).

In the play, the king of Thessaly – an appallingly self-interested person called Admetus – has previously done the god Apollo a favour, and so Apollo does Admetus a favour in return. He arranges for him to extend his life and avoid death in the short term, if he can find someone to take his place and die in his stead.

Admetus immediately asks his father or mother to die for him, based on the assumption that they are old and will presumably die soon anyway. But the father, Pheres, and his wife turn down Admetus, and so he has to prevail on his own wife, Alcestis, to die for him, which she agrees to do.

The story of the play is based around the day of her death and descent to the Underworld, with some rather comic twists and turns along the way. Death (Greek Thanatos) is a character in the play, and he is delighted to have a young victim, in Alcestis, rather than an old one. “They who die young yield me a greater prize,” he says.

The light of day

There is a particularly spiteful encounter between Admetus and his father on the subject of young and old death:

Admetus:

Yet it would have been a beautiful deed for you to die for your son, and short indeed was the time left for you to live. My wife and I would have lived out our lives, and I should not now be here alone lamenting my misery.

Father:

I indeed begot you, and bred you up to be lord of this land, but I am not bound to die for you. It is not a law of our ancestors or of Hellas that fathers should die for their children! … You love to look upon the light of day – do you think your father hates it? I tell myself that we are a long time underground and that life is short, but sweet.

The Alcestis of Euripides, and other Greek myths, remind us, should we ever forget, that love of looking upon the light of day is a characteristic of human existence, both for the young and the very old.

Complete Article ↪HERE↩!

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Coronavirus is showing us how we’ve failed to manage the logistics of death

Madrid’s City of Justice building has been converted into a morgue for coronavirus victims.

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This is different from saying we need to talk about death and dying (which we also need to do). I mean instead that we should focus our minds on what the human corpse means in this new pandemic reality.

Consider the number of dead bodies in the world before coronavirus. Based on global mortality statistics, approximately 56,842,500 humans died over the course of 2019. That’s roughly 155,732 people a day.

In the US, approximately 2,898,060 people died that year, which means about 7,939 a day. In the UK, the death rate for 2019 was 620,268, averaging 1,700 people a day.

It is easy to gloss over these statistics, since most of us never really think about millions of dead bodies. But what these numbers illustrate is that dead bodies are an everyday constant, we just don’t pay attention to them unless our job directly involves the dead.

So dead bodies are completely normal -– until suddenly they’re not. Until a novel virus sweeps the globe and produces a dead body count with life altering repercussions.

In order to manage and cope with the millions of dead bodies produced every year, different countries create what I call a “national death infrastructure” or NDI. The various parts of this infrastructure range from the local (a neighbourhood cemetery) to the global (systems in place for international repatriation). But crucially, the National Death Infrastructure is largely invisible to most of our lives.

Now COVID-19 is making NDIs visible. Indeed, the coronavirus pandemic is relentlessly demonstrating what happens when NDIs are not prepared for an unplanned spike in human mortality. We have seen thousands of coffins unattended in Italy, temporary emergency morgues in New York, and Spanish officials storing dead bodies at an ice rink.

Disturbing as many people find these news stories, everything happening to manage COVID-19 corpses is from various “mass fatality” and “disaster victim identification” playbooks. I know this because, as director of the Centre for Death and Society at the University of Bath, I’ve participated in consultations on governmental postmortem preparedness.

What’s different, of course, is that most people already oblivious to the NDI are wholly unprepared to see dead bodies rapidly produced in multiple countries, at the same time, and reported hourly on the news.

Imagine though, if details were broadcast for a year on how every one of the around 56 million people across the planet died – how they died and in what circumstances. Seeing this kind of detail in death might help people realise how important the infrastructure dealing with dead bodies really is, and why it needs to be financially supported by national governments.

Because right now, huge numbers of families cannot mourn their dead in the ways they expect to. We have seen this situation before with AIDS-related deaths, where next-of-kin were told a funeral was unsafe because HIV caused the death.

As I explain in my new book, Technologies of the Human Corpse, none of this was correct but that didn’t stop it from being said. And now COVID-19 flips the situation on its head. Funerals are currently not safe because living family members could spread COVID-19 by interacting with fellow mourners. The human corpse, this time, isn’t the viral issue. So the kind of funerals many of us are used to will have to wait.

Body count

And even for the kind of services that are now taking place, funeral directors in the US and the UK are running out of personal protective equipment (PPE) and body bags.

Refrigeration trucks in New York serve as an expanded morgue.

This is a bigger issue in cities like London and New York, but it will quickly affect small places too. Funeral industry workers are the essential frontline staff that both the living and the dead critically need right now, and like their colleagues in medicine and pathology, they are putting their lives at risk to ensure the national death infrastructure operates.

The current situation is not sustainable and governments will need to move quickly to manage the ever increasing numbers of dead bodies and make sure the funeral industry front line has the supplies it needs. They will also need to be prepared for a public backlash if they fail to do so.

Right now we all seem to be suffering from what I call “virological determinism” – we are blaming everything on a virus, when in fact blame lies with human failure to adequately follow existing public health pandemic response and preparedness planning. Failure which has created a situation where for weeks and months to come we will be confronted by mounting mortality statistics and dead bodies. More dead bodies than most national death infrastructures can manage.

So we need to talk about dead bodies and we need to do it now. And we should never forget that the COVID-19 dead bodies are mounting up because humans failed to effectively anticipate what new viruses almost always do – create human corpses.

Complete Article ↪HERE↩!

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These Are The World’s Oddest Funeral Traditions

(Still In Practice Today)

When it comes to dealing with the dead, some countries have traditions that are a bit stranger than most.

by Vanessa Elle

Unique traditions help to preserve the history and identity of a particular culture. From Halloween practices to funerals, every culture has its own traditions when it comes to dealing with the dead. Keep reading to find out about some of the world’s oddest funeral traditions that are still practiced today.

Indonesia: The Funeral Takes Place Years After Death

In many countries, funerals are held only a short amount of time after someone passes away. But in eastern Indonesia, funerals amongst the Toraja ethnic group are sometimes held years after a person has died. The primary reason for this is that they are often larger-than-life events lasting anywhere from a few days to a few weeks and it sometimes takes a family that long to save up enough money to afford such an affair.

Between the moment a Toraja person dies and the moment they have their funeral, they are still kept in the family home rather than in a morgue. They are referred to as someone who is sick or sleeping rather than someone who has passed away and is even cared for, laid down, and symbolically fed.

Ghana: People Are Buried In Fantasy Coffins

Ghana has made headlines in the past for the fantasy coffins that are so popular in the African nation. The idea behind fantasy coffins is that people get the chance to rest forever after in a casket that represents something they were passionate about or something they achieved. For example, a fisherman might be laid to rest in an oversized fish while a businessman might choose a casket shaped like a Mercedes.

It’s common across many cultures to invest a lot of money into the ideal coffin and this tradition just takes the idea one step further. After all, a coffin serves as someone’s final resting place, so it only makes sense that it represents them properly.

Tibet: The Body Is Exposed To Vultures

Sky burials are common amongst the Vajrayana Buddhist communities of Mongolia and Tibet. After a person has died, their body is cut into pieces and left on a mountaintop, where it is exposed to vultures. The underlying belief behind the tradition is that the body becomes an empty vessel following death and must be returned to the earth while the soul moves on.

The practice dates back years and is still the most popular method of burial in Tibet today. Other cultures across the world have also been known to expose a corpse rather than bury or cremate it, including the Zoroastrians, a religious group that today is mostly found in India but can be traced back to pre-Islamic Iran.

Madagascar: Having A Last Dance With The Body

Amongst the Malagasy people of Madagascar, a person’s burial isn’t a singular event. According to the traditional famadihana ritual, the body is exhumed every five to seven years to take part in a celebration. During the ritual, the bodies are sprayed with wine or perfume and family members dance with them while a band plays.

Some take the opportunity to update the deceased person on family news or ask for their blessings. More importantly, during famadihana, people remember the deceased person and tell stories of them to keep their memory alive.

New Orleans: A Jazz Band Funeral Procession

Of course, a jazz funeral could only ever take place in New Orleans! This tradition involves a brass band that accompanies a person’s funeral procession. The idea behind it is that the streets are filled with music and the deceased person’s life can be celebrated in addition to their death being mourned.

The procession typically begins at the church or funeral home and marches all the way to the cemetery. The music steadily becomes more upbeat as the march goes on and people begin to dance, with passersby also encouraged to join in on the dancing.

Complete Article ↪HERE↩!

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Dreams and other signs bring comfort to grieving people

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We’ve all had dreams. Some people dream vividly and often, some not as often. And there is the problem of forgetting the dream when you wake up, or shortly thereafter. I usually try to make a note to myself right away or when the dream wakes me up. I keep a bedside notebook for ideas, etc. Otherwise they are just forgotten.

And there are many types of dreams — happy and pleasant, wishful thinking, nightmares, anxiety dreams such as being lost, and, most difficult of all, distorted or mixed up dreams with the characters and events all combined and scrambled. There are many types of dream analysis, as well: ways to try to interpret the meaning of dreams. And we also have our own ideas about what a dream means.

But there is a special type of dream in grief, in which your loved one appears as if in life.

This can be very comforting. You are lucky to get one of these once in a while. I’ve had a few over the years and cherish them. They create a happy sensation, even after I wake. One vivid one I had a year or so ago was just a normal scene with my beloved Baheej’s arms around me. That was nice. A blessing. He appears in dreams occasionally but not very often.

There are lots of anxiety dreams in grief. Usually along the lines of being left alone, abandoned or other stressful scenes. Or danger where you can’t save the other. Or you can’t find him or her.

So dreams are a mixed bag. And they are different from “signs,” which are almost always pleasant and encouraging in my experience — and among people who’ve talked to me about signs. They are happenings/messages that serve as communication from lost loved ones, easily recognized by the bereaved, and very comforting.

The problem with signs is most people, unless it’s happened to them, think it’s just a person’s imagination, wishful thinking, or some fantasy because of grief. Or they think the sign is just a coincidence. But I continue to believe signs are a method of communication from the lost loved one. It’s a reassurance that they are still around and watching out for you.

Some people even experience a visual visit from a spirit, but this has never happened to me. It did happen to my sister and a couple of friends. I always hope my dear Baheej may appear someday, but not so far.

A while back, I got an email from a reader who described a sign he and his wife got from the adult son they lost. It was graphic and quite clear to them. How nice.

Last night I was talking with a close friend who had a huge sign from her father-in-law who died a few days ago. She went into the city alone to see a big art exhibit, and felt she was doing it not only because of her personal interest, but also in memory of her father-in-law, who loved art and would have enjoyed this exhibit.

Well, as she was walking around the gallery, there was a couple near her. From the back, the man looked like her father-in-law and seemed to be dressed like him. He turned around and looked just like him, but 10 years younger. He had on the same clothing, shirt and vest, of the same brand and style her father-in-law always wore.

My friend was surprised so she approached the couple and told them. They said to her, “Of course, he’s probably here with you now.” Wow. So I immediately said, “That’s a sign.”

This is how it happens, totally unexpected but clear as a bell.

My friend told me, “I think you have to be very open to recognize these signs when they happen.” I agree with her.

I’ve written about signs with lots of examples in earlier columns, so won’t repeat those. But here are a couple more examples:

Once I was at a swap shop in New Hampshire and I picked up (free) two darling flower watercolor drawings. Each is about 8 inches square, with matching frames. They now hanging in my dining room. One is the July water lily. It’s my husband Baheej’s favorite flower and his birthday month. The other is the December rose, my father’s birthday month. The two most important men in my life. My brother Nic had died shortly before. I expect to find the Nic’s April flower one of these days — my brother’s birthday month, and it’s also my mother’s.

Another sign is a feather. It’s widely thought to be a sign from a lost child or infant and, I think, could also be from someone young in spirit. Baheej was one of the latter; he had a really young joy of life. Well, in the first month or two after his death, I found many feathers around the yard, on the patio, even one in the house. My cats never go outside, so it wasn’t them. And I don’t have any pet birds.

I’ve only found one feather ever since. However, a friend who lost an infant found many, many feathers. Signs as far as I’m concerned.

So the point is: There are some extrasensory phenomena that happen in grief, chief among them dreams and signs. I think everyone agrees we all have dreams. So if you are lucky enough to have pleasant dreams of your lost loved one, whether spouse, partner, friend, child, parent or other, you are very fortunate.

Life is so complicated. And so is death. We just need to be as open as possible. Comfort comes in many forms.

Complete Article ↪HERE↩!

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Death of the funeral

Trends in commemorating those who die are shifting away from tradition. And, as the population ages and times change, the City of Kamloops is looking at how to manage the dead


A statue of Jesus stands among the remains of loved ones in a mausoleum at the city’s Hillside Cemetery. Funerals with large gatherings are on hold amid the COVID-19 pandemic.

By Jessica Wallace

Dead are the days of traditional casket burials for all.

These days, a dying man’s wish may be to grow into a tree, while another may choose to be buried in a certified eco-friendly cemetery.

Last spring, Washington became the first state in the U.S. to legalize human composting.

Funerals — once a place for obligatory tears and dark clothing — are today often substituted with a “celebration of life,” complete with funny stories and laughter.

Trends in dying are shifting away from tradition. And, as the population ages and times are changing, the City of Kamloops is looking at how to manage the dead, with an update to its Cemetery Master Plan.

The plan focuses on the city’s primary cemetery, Hillside Cemetery on Notre Dame Drive.

City civic operations director Jen Fretz said the plan will address current trends as traditional casket burial declines in popularity.

More common these days is cremation, Fretz said, noting the plan will look at demand for increased mausoleum space at Hillside Cemetery. The current mausoleums, she said, are “fully subscribed.”

Schoening Funeral Service manager Sara Lawson lauded the city’s planning, telling KTW the industry is rapidly changing.

She said some people may be surprised to know that in British Columbia, 85 per cent of people are cremated after death, with 15 per cent buried in a casket.

In Kamloops, that number is slightly lower, at 80 per cent and 20 per cent, respectively.

The overall trend, however, is a rise in cremation. Lawson believes that is happening for multiple reasons, primarily a new generation and loss of tradition.

“Newer generations aren’t attending church as much as grandma and grandpa,” Lawson said. “Back in the day, that’s what you did. You had a casket burial. You had service at the church.”

Another reason cremation is increasingly popular is due to urgency for gathering that comes with casket burial and desire for options. For example, if a family cannot unite in one place for some time until after a loved one’s death, cremation might make more sense. Perhaps everyone wants to meet in a place that was meaningful to the deceased.

“It happens more and more where there is a bit of a delay for the service,” Lawson said.

In addition to mausoleum space, the city will explore trends in green burials.

The Green Burial Council describes a green burial as a way of caring for the dead with “minimal environmental impact that aids in conservation of natural resources, reduction of carbon emissions, protection of worker health and restoration and/or preservation of habitat.”

Green burial requires non-toxic and biodegradable materials.

Lawson said only one cemetery in B.C. is certified to meet green burial standards — Royal Oak Burial Park in Victoria, which opened in 2008.

According to its website, Royal Oak is the first urban green burial site in the country, where it “returns human remains to the earth in a simple state permitting decomposition to occur naturally and so contribute to new life in a forest setting.”

Green burial prepares the body without embalming.

The body is buried in a biodegradable shroud, simple container or casket made from natural fibre, wicker or sustainably harvested wood.

Lawson said the difference between regular cemeteries, such as Hillside, and a green cemetery is the grave liner. While most cemeteries have grave liners made of concrete, wood or fibreglass, green cemeteries use dirt as a way to return remains to the elements as quickly as possible.

Schoening does offer green options, but there is no green burial site in the B.C. Interior. Green burials are not yet a common request, Lawson said, but she expects it will become more in demand in the next five to 10 years.

The city will also explore the potential for a scattering garden, which is a place to scatter ashes. Lawson said scattering gardens may look like flower gardens, wherein ashes can be scattered for a fee.

Compared to scattering someone’s ashes in a backyard or elsewhere in nature, cemeteries are permanent — meaning loved ones won’t return to that special location one day to find a development in its place, a rose garden dead or a tree chopped down.

“Cemeteries stay the same,” Lawson said. “The record must remain forever.”

Updates to the Cemetery Master Plan are expected by the fall.

With need for expansion of the cemetery, rates may also be on the rise.

The city said its fees are between 20 to 25 per cent lower than similar-sized communities and the goal is to recover operating costs with revenue collected.

MODIFYING THE MEMORIAL

While funeral servcies undergo a transition, a Kamloops pastor has noticed memorials are also changing.

Rev. Steve Filyk, a minister at St. Andrew’s Presbyterian Church, said newspaper obituaries increasingly state “no funeral by request.”

He suspects it is due to the taboo nature of death. As a culture, he said, people don’t want to acknowledge death, as it is finite.

“Perpetual youth is sort of what the focus of our culture is, right? In that way, I don’t know how well prepared we are to face it — to face the loss of loved ones or face our own death,” he said.

Filyk said he worries about the psychological impact of not marking someone’s death.

“I think to set apart and designate a time, not just for yourself but for everyone, where the world will stop for a few moments. It’s about that,” Filyk said.

“A moment of silence at Remembrance Day, where the world just stops to acknowledge that this person was special. They had warts and foibles, but they were special to a bunch of people and had an impact and that their loss is felt. I think it’s important to acknowledge that.”

Of memorials that do occur, Filyk said they rarely involve a casket and often involve photo slideshows in an increasingly media-driven, photo-centric society.

In addition, Filyk said he has noticed memorials are getting longer and are often called celebrations of life.

Regardless of whether people follow a faith tradition, Filyk said it is important to acknowledge wisdom from centuries past.

Memorials can be secular or religious, he said, noting there are unique ways to honour someone. with the better memorials providing opportunities to share stories.

“Any story often reveals something interesting about who they were and I think there’s something about telling those stories that somehow helps us heal,” Filyk said.

“Maybe because we’re all together having that similar focus.”

Complete Article ↪HERE↩!

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Deciding who lives and who dies

By Dr. Morhaf Al Achkar

I could soon be the physician following a policy that determines who would be denied medical care. At the same time, I could be one of those forbidden care if I needed it.

Medical leaders in Washington state quietly debated a plan to decide who gets care when hospitals fill up. Not many details are out, but the arguments echo a similar discussion in Italy, where an intensive-care unit protocol withheld life-saving care from certain people. The rejected were those older than 80 or who had a Charlson comorbidity index of 5 or more. With my diagnosis of stage IV lung cancer, I score a 6!

When I read the news, I was morally troubled, enraged and mortified.

I am in the same boat as many colleagues who have health issues or are older and could be asked to return from retirement or work accommodation to help out. Are we asking individuals to risk their lives, but will refuse them treatment if they get sick?

I am not familiar with empirical, objective evidence to support setting a threshold for who should or should not receive care as a way to improve outcomes for a community. Research to answer such an empirical question would have been unethical to start with. Using such a strategy also misuses predictive tools.

Age or the Charlson comorbidity index can help give an estimate of prognosis. But they cannot tell us how an individual person would fare in response to treatment for COVID-19. And if we want to decide who receives care, how can we forget about functional status, quality of life, and the person’s values and preferences?

Besides, the risk of eroding people’s trust is intolerable. The last thing we want is for people to lose confidence that they will be treated fairly just because of their health conditions or age. Do we intend to make such policies available to the public, or do we keep them secret so only people with privilege will know about them?

This is not the story we want to leave for history. And who said that an order from a health authority takes the moral burden off your shoulders? Have we forgiven the doctors in Nazi Germany who experimented with vulnerable patients? We humans carry moral responsibility for our actions. If anything, blindly following an unjust order doubles the burden. Worse than doing what is unjust is not standing up to advocate for the vulnerable. What will be remembered is that we pacified our consciences with a piece of paper we called a “policy.”

We can do better.

Restricting people from accessing care is not the only strategy. We can continue to shift resources to optimize the work. For example, a generalist can lighten the load for the specialist. A well-trained practitioner can supervise a less-trained one. Since the epidemic is not hitting every U.S. city with the same intensity, sick people can be moved around.

If we think we cannot save everyone, let’s invite people to have conversations about death and dying. Patients and their primary-care doctors should discuss advanced directives. The patient can sign a do not resuscitate order. People could even embrace death with dignity if they live in a state that allows it.

I can make the choice to not live and forfeit my right to care. But that right cannot be taken from me. Age or health conditions cannot alter a person’s entitlement.

We can trust doctors’ abilities to make the right moral decision, and we can give them the authority and support in so doing. In today’s hyper-complex context, medical doctors should be competent to manage, case-by-case and situation-by-situation.

Yes, it will be a difficult time. When a decision has to be made between two lives, we regret having to make the decision, and we express our deep sadness. We should not make such unfortunate decisions a norm, and we should not write a policy to make it OK. It is not OK, and it will never be.

The healthcare system has a terrible track record of failing various marginalized groups. But we do have a good track record of providing exceptional care to people. Let’s take the opportunity to do it right this time and not miss our chance, because if the public perceives a failure on our part, their trust will take decades to regain.

Complete Article ↪HERE↩!