Category: Dying Wisely and Well

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How to Die Well

By Jessica Nutik Zitter

[I] first met Stephanie in the Intensive Care Unit. She was an urgent admission — in shock, her blood pressure was almost unmeasurable. Over the previous month, the rate of cancerous fluid building up around her lungs had increased. She had used the permanent drainage tube in her chest wall more frequently to manage her shortness of breath. But in the process, she had made her blood pressure dangerously low. She was unconscious and mumbling incoherently. Her kidneys and liver weren’t getting enough blood and were effectively dying. We worked quickly. And we were lucky enough to be able to rehydrate her before her organs became permanently damaged. Slowly, she woke up again. We had saved her.

Stephanie was a 60-year-old wife, mother and grandmother. She loved life. Wine tastings, gardening, spending time with her family — this didn’t stop when she was diagnosed. When she had learned that the cancer had spread to the other lung and brain, she took a deep breath and went back into the ring to fight. She signed up for more chemotherapy. If she worked hard, she thought, she could beat it.

I wanted to celebrate with Stephanie and her family — she was no longer in critical condition — but I couldn’t. Our “fix” wasn’t going to change the fact that her cancer would continue to worsen. And fast. More chemotherapy would not save this woman. I had to tell her the truth.

When I walked into the room, Stephanie’s daughter Becky was giving her a massage. I thought of a manager preparing his boxer to return to the ring. “We’re ready to get back in there and fight,” Becky told me. “Bring on the chemotherapy.” Stephanie looked tired, but nodded. I took a deep breath and sat on the side of the bed.

I explained that it was only a matter of time before Stephanie’s organs failed again. The next time, she probably wouldn’t be so lucky. The corners of Stephanie’s mouth pointed down, like two arrows, and I wasn’t sure if she was getting ready to cry or yell. “Please leave,” Becky said.

I had done the right thing, but nonetheless I felt ashamed. I wasn’t the doctor they had been hoping for. I wasn’t their hero.

We all know we will die. But somehow none of us believes it. This is a serious obstacle to dying well.

To start to find a way to experience a better end, we need to reflect on our own deaths and begin the process of accepting our mortality. This may happen through meditation, writing or conversations. Of course we should have hope if illness strikes us, but hope for perpetual life is blind. As we age or grow ill, the goal may switch from hope for longer life to hope for more attainable goals like healing relationships, living pain-free and enjoying a glass of Cabernet.

Simultaneously, we must prepare for this final stage of life. We must consider our preferences and values and shared them with our loved ones. Stephanie cared about being at home, with her family. What is most important to you? What would be most important to your loved ones? One day you might be called on to represent them. This conversation should happen repeatedly over the years, through the various stages of life and changes in health.

We must all — doctor, nurse, patient and family — also remember that these decisions require the collaboration of a whole team. The doctor is indeed the expert on the disease, but the patient is the expert on the patient. If you feel that you are not being included in decision-making for yourself or a loved one, or you don’t feel the team is communicating well, request a palliative care consultation, which brings communication expertise into the picture.

Two days later, I went upstairs to check on Stephanie and her family. I was no longer responsible for the case. Still, I worried that I had upset them, and I wanted to check in. I was dreading it.

But when I reached the room, there was Stephanie sitting in a wheelchair, smiling. She was going home that day. The family had had some time to absorb the news, and then they had changed the course of care. They had met with a hospice service. No more hospitals. No more chemotherapy.

Stephanie enjoyed the last two months of life with the support of hospice, her family and several bottles of good wine. Her funeral, which I attended, was replete with wonderful stories and not an ounce of regret. She died in my arms, Becky said, and it was as loving and peaceful a death as you could imagine.

Stephanie’s last couple of months might have looked very different. Like many of my patients, she could have died attached to machines. She could have been isolated from her family instead of in a cozy bed in the middle of the living room. And rather than the taste of wine and crackers, she could have had breathing and feeding tubes filling her mouth.

I’ve seen so many patients, so many lives, so many deaths. Far too few have the opportunity to live the life they would choose all the way through to the end. I believe deaths like Stephanie’s should be the rule, rather than the exception. And that is going to take some work from all of us — in the form of reflection, preparation and collaboration.

When it comes to death and dying, the answer is found in honest communication and human connection rather than technology and protocols. We’ve achieved amazing things in modern medicine. Our tools can serve to bring the dying back to life. But too often they take life away from the dying.

Complete Article HERE!

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How to Find Meaning in the Face of Death

The time between diagnosis and death presents an opportunity for “extraordinary growth.”

 

By Emily Esfahani Smith

[T]he psychiatrist William Breitbart lives at the edge of life and death. As chairman of the Department of Psychiatry and Behavioral Sciences at Memorial Sloan Kettering Cancer Center in New York, Breitbart specializes in end-of-life care for terminally ill cancer patients. For many of his patients, the most pressing question isn’t when they’ll die or how painful death will be. Rather, it’s what makes life meaningful. They are in search of a meaning that cannot be destroyed by death.

Is there one?

Breitbart has spent the better part of his career trying to answer that question. His ground-breaking research shows that while the specter of death often leads people to conclude that their lives are meaningless, it can also be a catalyst for them to work out, as they never have before, the meaning of their lives.

When people believe their lives are meaningful, according to psychologists, it’s because three conditions have been satisfied: They feel their existence is valued by others; they are driven by a sense of purpose, or important life goals; and they understand their lives as coherent and integrated. Psychologists and philosophers say that the path to meaning lies in connecting and contributing to something that is bigger than the self, like family, country, or God.

Meaning and death, Breitbart believes, are the two sides of the same coin—the fundamental problems of the human condition. How should a human being live a finite life? How can we face death with dignity and not despair? What redeems the fact that we will die? These questions roll around Breitbart’s mind every day as he works with patients facing life’s end.

Breitbart’s interest in meaning took root in his childhood. Born in 1951, Breitbart grew up on the Lower East Side of Manhattan. His parents, Jews from eastern Poland, narrowly avoided Hitler’s death camps. When they moved to America, they carried their memories of the war years with them. Breitbart’s childhood was steeped in that tragic past. Every morning, his mother would ask him at the breakfast table, “Why am I here?” Why, she wondered, did she live when so many others had died?

“I grew up with a sense of responsibility to justify my parents’ survival and to create something in the world that would be significant enough to make my life worthwhile. It’s no coincidence,” he laughed, “that I ended up at Sloan Kettering.”

Breitbart began working at the hospital in 1984 during the height of the AIDS epidemic. Young men his age were dying all around him. As he tended to them, “They were constantly asking me to help them die,” he said. He was also working with terminal cancer patients. “When I walked in the room, they would say, ‘I only have three months to live. If that’s all I have, I see no value or purpose to living.’” They told him, “If you want to help me, kill me.”

If death means non-existence, Breitbart’s patients reasoned, then what meaning could life possibly have? And if life has no meaning, there’s no point of suffering through cancer.

By the ’90s, physician-assisted suicide was a hot topic in Breitbart’s circles and beyond. The doctor Jack Kevorkian had helped his first patient end her life in 1990. As the United States debated the ethics of assisted suicide, other countries were taking steps toward normalizing the practice. In 2000, the Netherlands became the first nation to make physician-assisted suicide legal. Today the practice is legal in the United States in California, Vermont, Montana, Washington, and Oregon.

As Breitbart heard more stories of assisted suicide, he began to wonder what specifically was driving the terminally ill to give up on life. At the time, he was doing research studies on pain and fatigue at the end of life, so he tacked onto those studies some questions that asked his subjects whether they felt a desire for a hastened death. What he discovered surprised him.

They no longer wanted to die. Their spiritual wellbeing improved. They reported a higher quality of life.

The assumption had been that the ill chose to end their lives because they were in terrible pain. But Breitbart and his colleagues found that wasn’t always the case. Instead, those who desired a hastened death reported feelings of meaninglessness, depression, and hopelessness. When Breitbart asked patients why they wanted a prescription for assisted suicide, many said it was because they had lost meaning in life. Unlike clinical depression, which has a specific set of diagnosable symptoms, meaninglessness was more of an “existential concern,” Breitbart said—a belief that one’s life has little value or purpose and is, therefore, not worth living.

Breitbart knew he could treat depression—there were medicines and well-developed psychotherapies for that—but he was stumped when it came to treating meaninglessness. Then, in 1995, he began to see a way forward. He was invited to join the Project on Death in America, which aimed to improve the experience of dying. Breitbart and his colleagues on the project—including philosophers, a monk, and other physicians—had long conversations about death and the meaning of life, “peppered with references to people like Nietzsche and Kierkegaard and Schopenhauer,” Breitbart said. “What I suddenly discovered,” he explained, was that “the search for meaning, the need to create meaning, the ability to experience meaning was a basic motivating force of human behavior. We were not taught this stuff at medical school!”

Breitbart became convinced that if he could help patients build meaning, he could decrease their suicidal thoughts and make their lives worth living even to the very end.

He developed an eight-session group therapy program where six to eight cancer patients come together in a counseling workshop. Each session, in one way or another, helps build meaning. In the first session, for example, the patients are asked to reflect on “one or two experiences or moments when life has felt particularly meaningful to you.” In the second session, patients respond to the question “Who am I?” to tap into the identities that give them the most meaning. One woman responded saying, “I’m somebody who can be very private … [and] have been working on accepting love and affection and other gifts from other people.” In subsequent sessions, they share their life story with the group and think about the role that love, beauty, and humor played in their lives.

In the final session, the patients reflect on the part of them that will go on living even after they are dead—their legacy. That could be their soul, or it could be something they helped to create that will continue to exist—their children, a work of art, or an organization. They present a “legacy project” to the group, generally something they do or create that represents how they want to be remembered. One man brought in a woodcut of a heart sculpted into a Celtic Trinity. “This is what I will teach my children,” he said, “that there is eternal love, and that I will be there for them, far beyond my passing.”

Breitbart performed three randomized, controlled experiments on the meaning-centered psychotherapy. When he analyzed the results with his colleagues, Breitbart saw the therapy had been transformative. By the end of the eight sessions, the patients’ attitudes toward life and death had changed. They were less hopeless and anxious about the prospect of death than they were before they began the program. They no longer wanted to die. Their spiritual wellbeing improved. They reported a higher quality of life. And, of course, they found life to be more meaningful. These effects not only persisted over time—they actually got stronger. When Breitbart followed up with one group of patients two months later, he found that their reports of meaning and spiritual wellbeing had increased, while their feelings of anxiety, hopelessness, and desire for death had decreased.

The time between diagnosis and death, Breitbart has found, presents an opportunity for “extraordinary growth.” One woman, for example, was initially devastated by her diagnosis of colon cancer—but after enrolling in the therapy program, she realized, “I didn’t have to work so hard to find the meaning of life. It was being handed to me everywhere I looked.” And that realization ultimately brought her—and Breitbart’s other patients—some measure of peace and consolation as they faced life’s final challenge.

Complete Article HERE!

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Going up yonder from your home

By Gerald W. Deas M.D., MPH

[D]uring my many years of medical practice, I have made many house calls on folks who were going to their eternal rest. Often, loved ones from the family have suggested that the person be hospitalized. In some cases, I had no alternative but to do so. But at other times, after surveying the home conditions and finding that they were accommodating, I have suggested to the family that I take care of the patient at home until he or she had completed the journey to the everlasting.

I am convinced that patient’s lives are extended when they are kept at home. They can hear familiar voices and songs. They can see the familiar faces of their loved ones. Often, they can taste that home-cooked food, which gives them nourishment. They are comfortable in clean beds with fluffy pillows and warm blankets. They can feel the touch of kind and gentle hands. All of their five senses are satisfied as they begin their death dream knowing that they will awaken satisfied with going home from home.

After reading the book “Ethical Ambition; Living a Life of Meaning and Worth” by the great author Derrick Bell, who recently passed, I was struck by a passage in the book that stated the following: “Life is a gift that can be revoked at any time, and that, at some point, will come to an end. And, at that end, we know our work will not be completed. Perfection will have evaded us as it has for all who came before us. If there is satisfaction, it must come from our striving toward that vision of a better world.” This statement certainly is a long quote from his book, but I think it crystallizes my thoughts on life and death.

Bell also quotes from a book by Mitch Albom entitled “Tuesdays With Morrie.” Morrie, suffering from the last stages of Lou Gehrig’s disease, tells his former student Mitch, “Everyone knows that they are going to die, but nobody believes it. If we did, we would do things differently. … There’s a better approach. To know you’re going to die, and to be prepared for it at any time. That’s better. That way, you can actively be more involved in your life while you are living.” After I read these statements from this wonderful book again, my philosophy of life and death was also strengthened.

Another book recently completed has the wonderful writing of the Rev. Paul Smith, senior minister of the First Presbyterian Church of Brooklyn Heights, entitled “The Deep Calling to the Deep: Facing Death.” This book should be read by everyone, because we all will be facing death.

Smith gives a day-to-day account of his ministry to six folks who were dying and how they and their families were comforted to know that death is not the worst thing that can happen in your life. Smith writes about the “good death” and quotes Dr. Howard Thurman as follows: “A good death is made up of the same elements as a good life.”

What is a good life and a good death? I suggest that you read this enlightened work and find out. I certainly did. I believe that all physicians, medical students and theologians should read this book as a must in their training.

Going up yonder, I feel, completes our journey on this planet, a most desirable conclusion.

Complete Article HERE!

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This Study Reveals The 5 Biggest Regrets People Have Before They Die

With just a few weeks to live, these are the biggest regrets most people have

By

[D]o you have any regrets?

Most people do.

But it appears our regrets gain a lot of weight as we approach the end of our lives.

For many years, Bronnie Ware – an Australian nurse and counselor – worked in palliative care; taking care of terminally ill people, most of whom had less than 12 weeks to live.

Her patients were typically old people with very serious illnesses, waiting to die.

And a lot of her work involved providing counseling and relief from the physical and mental stresses that come naturally when a human being comes face to face with their mortality.

Death is not a comfortable subject for most people. We prefer to not think or talk about it.

But the sad truth is, all of us will die someday.

Knowing you are going to die in a few weeks is a very bitter pill to swallow. And Bronnie noticed as her patients experienced a range of emotions that usually started with denial, and then fear, anger, remorse, more denial, and eventually, acceptance.

As part of therapy, Bronnie would ask about any regrets they had about their lives, and anything they would do differently if life gave them a second chance.

Of all the responses she got from her patients, she noticed there were 5 regrets that stood out. These were the most common regrets her patients wished they hadn’t made as they coursed through life.

But the regrets of the dying can be sound and invaluable advice for the living.

And that’s why it’s a really good thing you’re reading this article.

One of the key revelations from Bronnie’s study is that we often take our lives for granted because we are healthy.

Health affords us boundless freedom very few realise, until we no longer have it.

But while her dying patients were helpless in the face of their regrets, you and I still have time to do something about our regrets, before it’s too late.

Let’s now look at each of the 5 most common regrets Bronnie observed:

1)    I wish I pursued my dreams and aspirations, and not the life others expected of me

According to Bronnie, this was by far the most common regret of all.

When people realise their life is coming to an end, it becomes easier to look back and see all those dreams they had but didn’t have the courage to pursue.

In many cases, their failure to pursue those dreams were often due to fitting into the expectations of others – usually family, friends and society.

One of her dying patients, Grace, made Bronnie promise that she would pursue all her dreams and live her life to its fullest potential without ever considering what others would say.

According to Bronnie, Grace was in a long but unhappy marriage. And after her husband was put in a nursing home, she was diagnosed with a terminal illness. And Grace’s biggest regret was that she never was able to pursue all the dreams she put on hold.

I think the biggest lesson from this regret is, if you know what really makes you happy, do it!

It appears that our unfulfilled dreams and aspirations have a way of silently stalking us, and eventually haunt our memories in our dying days.

And if you’re afraid of what people will say about your choices, remember that their voices will not matter to you in your dying days.

2)   I wish I didn’t work so hard

This one makes me feel guilty.

According to Bronnie, this regret came from every male patient she nursed. And a few female patients too.

As breadwinners, their lives were taken over by work, making a living, and pursuing a career. While this role was important, these patients regretted that they allowed work to take over their lives causing them to spend less time with their loved ones.

Their regrets were usually about missing out on the lives of their children and the companionship of their spouse.

When asked what they would do differently if given a second chance, the response was quite surprising.

Most of them believed that by simplifying our lifestyle and making better choices, we may not need all that money we’re chasing. That way, we can create more space in our lives for happiness and spend more time with the people who mean the most to us.

3)   I wish I had the courage to express my feelings and speak my mind

This one just made me so much bolder. 🙂

According to Bronnie, many of her dying patients believed they suppressed their true feelings and didn’t speak their mind when they should have, because they wanted to keep peace with others.

Most of them chose not to confront difficult situations and people, even when it offended them. By suppressing their anger, they built up a lot of bitterness and resentment which ultimately affected their health.

Worse still, harbouring bitterness can cripple you emotionally and stand in the way of fulfilling your true potential.

To avoid this type of regret later in life, it’s important to understand that honesty and confrontation are a necessary part of healthy relationships.

There is a common misconception that confrontation is bad for relationships and can only create division.

Not all the time.

In reality, when confrontation is kind, honest and constructive, it helps to deepen mutual respect and understanding and can take the relationship to a healthier level.

By speaking our minds, we express our true feelings and reduce the risks of building up unhealthy stores of bitterness that ultimately hurt us.

4)   I wish I had stayed in touch with my friends

This one is a regret many of us struggle with.

Bronnie found that her patients missed their old friends and regretted they didn’t give those friendships the investment of time and effort they deserved.

Everyone misses their friends when they’re dying.

It appears that when health and youth have faded, and death is looming, people realise that some friendships hold more value than all their wealth and achievements.

According to Bronnie, it all comes down to love and relationships in the end. Nothing else mattered to her patients in the last few weeks of their lives but love and relationships.

We live in a busy world these days. And the pressures and demands of work, city life and trying to raise a family can take its toll on some golden relationships.

Knowing this now, what would you do differently?

5)   I wish I had let myself be happier

This is a very humbling one, really.

Many of her patients didn’t realise until the end of their lives that happiness is a choice.

They wished they had known that happiness isn’t something to be chased and acquired through wealth, social acceptance and the trappings of life.

In their deathbeds, these patients realized they could have chosen to be happy, regardless of their circumstances in life – rich or poor.

To me, this regret is the most touching.

Throughout our active lives, we often focus too much on acquiring the things we would like to have – wealth, status, power and achievement. We often (wrongly) believe that these things hold the keys to our happiness.

When asked what they could have done differently, here’s the key message those dying folks shared: Learn to relax and appreciate the good things in your life. That’s the only way to find real happiness.

Happiness is a choice.

Is it possible to live a life without regrets?

This is the big question I’ve been asking myself.

As no human being is perfect, and I doubt there’s anything like a “perfect life”, I expect all of us would have some regret(s) in our dying days.

But I think the key is to have as few regrets as possible.

And the best way to die with very few regrets is to live life as if we would die today.

After all, almost nobody knows exactly when they’ll die.

By living our lives as if the end is nigh, we would realise that we really don’t have all the time in the world. As a result, we would procrastinate less, and pursue our truest desires, dreams and aspirations.

Also, to live a life of few regrets, we have to focus on and accommodate ONLY those things and people that make us happy. Because if we try to conform to the expectations of others and hide our true feelings, the regrets could haunt us later in life.

If you’re reading this article and you’re alive and healthy, you still have a choice.

Remember, you only live once!

Don’t forget to share this article with people you care about. You may just save someone a ton of regrets.

I wish you an amazing life.

Complete Article HERE!

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How to die well

Lack of faith is no impediment to a decent death – or to helping another through theirs

Stand by me: Shailene Woodley and Ansel Elgort as cancer patients who fall in love, in The Fault In Our Stars.

By Johannes Klabbers

In the secular age you don’t need special authorisation to console a dying person. Just learning what it means to be there for someone is enough.

“Death literacy” is officially a thing. People go to death cafés; books about death are in demand… and around 55 million people worldwide do it every year. But how do you actually do dying well? And who can dying people turn to for support?

Although I know exceptional doctors and nurses who can and do talk with patients about their looming demise, it is something that many don’t feel qualified to do.

Traditionally, expertise in dying was thought to be the remit of religion. The Catholic church recently revived their medieval handbook for dying people, Ars Moriendi, now illustrated with drawings of happy families rather than demons, like the original, and handily available in the form of a website: artofdyingwell.org.

But what are the options for atheists or agnostics today? When it comes to thinking about what it means to be mortal, many people find themselves in a kind of secular vacuum. But living a life without religion doesn’t mean that you have to be alone at the end.

As a secular pastoral carer, I learned that consoling a seriously ill and dying person is something that almost anyone can do, whatever their faith – or lack thereof. You don’t need a special qualification, or a badge, or permission from an authority figure, supernatural or otherwise, just your humanity and determination – and for the suffering person to want someone to be there with them.

The first crucial step is turning up. Too often, our anxiety about saying or doing the “wrong thing” leads us to decide not to visit someone. Offering to be there for someone, even if they decline – and they might – is never wrong. Being there for someone means giving your attention to the person not to their illness, and concentrating on listening, not on worrying about what to say.

You will need to accept that the dying person may not want to discuss their sadness and fears – at least at first. They may want to talk about the football or the latest episode of Bake Off. Or they may just need someone to sit with them in silence.

Remember that it is not unreasonable to feel awkward. You might feel uneasy in the setting, or be distressed by their appearance. But your job is to accept your discomfort and think beyond it. You can show sadness, but do not burden them with your grief. You may need to be supported and comforted yourself afterwards.

While there might not be any formal qualifications in death literacy with which you can arm yourself, there are a number of wonderful, entirely secular, books by brilliant writers who are in the process of dying or supporting dying people, from Jenny Diski’s In Gratitude (to Tom Lubbock) and Marion Coutt’s memoirs, which together form an awe-inspiring document of courage, humility and humanity.

There is a moment which perfectly illustrates how to console a dying person in the Dutch author Connie Palmen’s moving memoir Logbook, when her husband, a leading Dutch politician, lies dying. In a moment of lucidity he sits upright and exclaims, “I am sorry for my sins!”

“I absolve you,” Connie tells him.

Ultimately, our humanity is all the authority we need to offer consolation to dying people.

Complete Article HERE!

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Legalizing Aid In Dying Doesn’t Mean Patients Have Access To It


Dr. Lonny Shavelson heads Bay Area End of Life Options, a Berkeley, Calif., medical practice that offers advice and services to patients seeking aid in dying under the state law enacted last June.

 

By JoNel Aleccia

[I]n the seven months since California’s aid-in-dying law took effect, Dr. Lonny Shavelson has helped nearly two dozen terminally ill people end their lives with lethal drugs — but only, he says, because too few others would.

Shavelson, director of a Berkeley, Calif., consulting clinic, said he has heard from more than 200 patients, including dozens who were stunned to learn that local health care providers have refused to participate in the state’s End of Life Options Act.

“Those are the ones who could find me,” says Shavelson, who heads Bay Area End of Life Options and is a longtime advocate of assisted suicide. “Lack of access is much more profound than anyone is talking about.”

Across California, and in the five other states where medical aid-in-dying is now allowed, access is not guaranteed, advocates say. Hospitals, health systems and individual doctors are not obligated to prescribe or dispense drugs to induce death, and many choose not to.

Most of the resistance comes from faith-based systems. The Catholic Church has long opposed aid-in-dying laws as a violation of church directives for ethical care. But some secular hospitals and other providers also have declined.

In Colorado, where the nation’s latest aid-in-dying law took effect in December, health systems covering nearly third of hospitals in the state, plus scores of clinics, are refusing to participate, according to a recent STAT report.

Even in Oregon, which enacted the first Death with Dignity law in 1997, parts of the state have no providers within 100 miles willing or able to dispense the lethal drugs, say officials with Compassion & Choices, a nonprofit group that backs aid-in-dying laws.

“That’s why we still have active access campaigns in Oregon, even after 20 years,” says Matt Whitaker, the group’s state director for California and Oregon. “It becomes a challenge that causes us to have to remain extremely vigilant.”

In Washington state, where the practice was legalized in 2009, a Seattle hospice patient with advanced brain cancer was denied access to willing providers, so he shot himself in the bathtub, according to a 2014 complaint filed with the state health department.

“Refusing to provide information or appropriate referrals directly led to the unnecessarily violent death of this patient,” said the complaint filed by an anonymous hospice nurse. “I strongly believe this constitutes patient abandonment.”

Lack of access was also an issue for Annette Schiller, 94, of Palm Desert, Calif., who was diagnosed with terminal thyroid and breast cancer and wanted lethal drugs.

“Almost all of her days were bad days,” recalled Linda Fitzgerald, Schiller’s daughter. “She said, ‘I want to do it.’ She was determined.”

Schiller’s hospice turned down her request, and she couldn’t find a local referral, forcing Linda Fitzgerald to scramble to fulfill her mother’s last wish.

“I thought it was going to be very simple and they would help us,” says Linda Fitzgerald. “Everything came up empty down here.”


Annette Schiller of Palm Desert, Calif., who was 94 and diagnosed with terminal thyroid and breast cancer, had trouble finding doctors to help her end her life under California’s new aid-in-dying law.

Opponents of aid in dying cite providers’ reluctance as evidence that the laws are flawed and the practice is repugnant to a profession trained to heal.

“People consider it a breaking of professional integrity,” says Dr. David Stevens, chief executive of Christian Medical & Dental Associations, which has worked to stop or overturn aid-in-dying laws in several states.

But those decisions can effectively isolate people in entire regions from a legal procedure approved by voters, advocates said.

In California’s Coachella Valley, where Annette Schiller lived, the three largest hospitals — Eisenhower Medical Center, Desert Regional Medical Center and John F. Kennedy Memorial Hospital — all opted out of the new state law. Affiliated doctors can’t use hospital premises, resources or systems in connection with aid in dying, hospital officials said.

“Eisenhower’s mission recognizes that death is a natural stage of the life journey and Eisenhower will not intentionally hasten it,” Dr. Alan Williamson, vice president of medical affairs of the non-profit hospital, said in a statement.

Doctors may provide information, refer patients to other sources or prescribe lethal drugs privately, Williamson said.

“All we have done is say it can’t be done in our facility,” he added.

In practice, however, that decision has had a chilling effect, says Dr. Howard Cohen, a Palm Springs hospice doctor whose firm also prohibits him from writing aid-in-dying prescriptions or serving as an attending physician.

“They may be free to write for it, but most of them work a full day. When and how are they going to write for it?” he said. “I don’t know of anyone here who is participating.”

Patients eligible for aid-in-dying laws include terminally ill adults with six months or less to live, who are mentally competent and can administer and ingest lethal medications themselves. Two doctors must verify that they meet the qualifications.

Many doctors in California remain reluctant to participate because of misunderstandings about what the law requires, says Dr. Jay W. Lee, past president of the California Academy of Family Physicians.

“I believe that there is still a strong taboo against talking about death openly in the medical community. It feels like a threat to what we are trained to do: preserve and extend life,” Lee says, adding that doctors have a moral obligation to address end-of-life concerns.

There’s no single list of doctors willing to prescribe life-ending drugs, though Compassion & Choices does offer a search tool to find participating health systems.

“They don’t want to be known as the ‘death docs,’ ” says Shavelson, who has supervised 22 deaths and accepted 18 other people who were eligible to use the law but died before they could, most within a required 15-day waiting period.

Officials with Compassion & Choices said past experience indicates that more providers will sign on as they become more familiar with the laws and their requirements.

At least one California provider, Huntington Hospital in Pasadena, originally said it wouldn’t participate in the law, but later changed its position.

Other health systems have opted to not only participate, but also to help patients navigate the rules. Kaiser Permanente, which operates in California and Colorado, has assisted several patients, including Annette Schiller, who switched her supplemental insurance to Kaiser to receive the care.

Within weeks, Schiller was examined by two doctors who confirmed that she was terminally ill and mentally competent. She received a prescription for the lethal drugs. On Aug. 17, she slowly ate a half-cup of applesauce mixed with Seconal, a powerful sedative.

“Within 20 seconds, she fell asleep,” her daughter recalled. “Within a really short time, she stopped breathing. It was amazingly peaceful.”

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What does my family need to know about end-of-life care?

By Sunrise Senior Living

[T]he loss of a loved one is always a somber experience, but thankfully, due to the continuing advancements in health services, the number of Americans that are able to spend their final days in a comfortable and controlled setting is growing.

End-of-life care allows individuals to experience that final chapter in life with a dignified and calm feeling, as well as offer family members that peace of mind, support and a sense of comfort that can help ease that sorrow during this time. Being informed and conscious of this subject makes taking those steps in coordinating this care much easier and straightforward for everyone involved.

When is it time?
There are many conditions in existence that over time can become increasingly difficult and expensive to treat. This not only can be a burden for the patient, but can also create a painful and challenging experience as well. While deteriorating conditions and intolerable discomfort are two chief concerns when considering hospice care for a loved one, things such as complicated health care needs, sustained pain, and loss of mobility or capacity are also matters that should be taken into account.

It is hard to decipher the “right time” when deciding to make the decision to begin end-of-life care. Each and every family has a different approach and belief that can affect their decision. Ultimately, this choice is one that is deeply personal and involves tough choices for the whole group.

What does end-of-life care look like?
There are several types of end-of-life care available. Hospice care is for individuals that are nearing the end of their lifetime, with a terminal prognosis of six months or fewer. Palliative care is one that is more fitting for older adults living with a chronic condition and are in need of relief from the on-going pain and symptoms. In some cases, families may also choose to provide end-of-life care from home.

In either case, a full team of medical professionals and support staff work around the clock to make sure that patients are as comfortable and well-cared for as possible. Every facility is different, which means that nurses and doctors may be supported by home health aides, spiritual counselors and social workers depending on the circumstance.

With that being said, there are people dedicated to helping family members navigate this new challenge and providing guidance with whatever might come next.

Paying for end-of-life care
The Kaiser Family Foundation reported that hospice care is covered by Medicare for eligible older adults, usually individuals with a terminal diagnosis. This organization makes affording end-of-life care easier for many families.

Other than that, Medicaid, private insurance and other sources of payment such as a pension or retirement fund may be used to pay for these services. Families should discuss different payment models and work with a knowledgeable provider to uncover all available options.

Selecting the right partner
One thing families should understand when facing the possibility of end-of-life care is being aware of all available resources available that offer support and guidance during this difficult time. The care professionals at Sunrise Senior Living can advise and help coordinate care for an older loved one. With the help of Sunrise, the best, most appropriate end-of-life care can be identified and any transition can be made as smooth and as comfortable as possible.

Complete Article HERE!