What the death rattle and capital punishment have in common

By Joel B. Zivot and Ira Bedzow

Death rattle. That’s the sound some dying people make, caused by a buildup of mucus and other secretions in the throat as the body begins to slowly lose its life force. It can sound wet and crackling, or like a soft moan or snoring or gargling.

No one knows if a dying person finds the death rattle disturbing or distressing, as no one can pretend to know with certainty the inner subjective experience of anyone too ill to express it. The common medical assumption, though, is that they are not distressed by it. But the death rattle is disturbing to family members and loved ones who are with their loved ones as they are dying. They typically interpret the sounds as indicative of pain and the absence of a “good death.”

A team of researchers in the Netherlands conducted what they call the SILENCE clinical trial to see if an injection of scopolamine butylbromide, an antispasmodic drug, could stop, or at least reduce, the death rattle. It did.

In an accompanying editorial, two U.S. physicians make the case that administering a drug to reduce the death rattle is justified, even when one cannot know the inner experience of a dying patient. They claim that “when in doubt regarding comfort, it is best to try treatment.” They also write that it can relieve the distress not of the patient but of those bearing witness to the death.

The first reason reveals a technological imperative that is permeating health care delivery. The technological imperative says, “If it’s possible, it should be done.” While moral philosophers since Immanuel Kant have held that “ought implies can” — meaning that having a moral duty entails that one is able to fulfill it — the premise doesn’t work both ways. Shooting first (in this case a subcutaneous injection of scopolamine butylbromide) and asking questions later is not the best approach. Of course, it may become best practice to reduce the death rattle, but the medical profession should at least consider why before deeming it so.

The second reason — to alleviate the discomfort of those bearing witness — speaks to the current debate over the legality and morality of capital punishment, especially now when the Biden administration wants to reinstate the death penalty for Boston Marathon bomber Dzhokhar Tsarnaev, even though earlier this year the U.S. attorney general ordered a moratorium on federal executions.

Death by execution and death in the setting of end-of-life care have something in common. Both involve the presence and witness of interested parties. And what is witnessed — rather than what is occurring to the dying individual — matters a great deal.

The law stipulates that punishment cannot be cruel and unusual. The experience of execution also confronts society’s aversion to see itself as inhumane. But the absence of cruelty does not create humaneness. Punishment must not be tortuous or deliberately degrading and should not exceed the severity of the crime committed.

The Biden administration may see execution fitting for the crime of the Boston Marathon bombing. That decision will rest with the court. Whether or not execution on its face is inhumane, it is certainly extreme and should be used judiciously — not politically.

The idea that execution may be a form of torture is one of the primary reasons for its medicalization. The American Society of Anesthesiologists strongly discourages anesthesiologists from participating in executions, and says that legal execution “should not necessitate participation by an anesthesiologist or any other physician.”

Execution wrongly impersonates a medical act and the impersonation is so convincing that even doctors and the public are fooled. In the United States, no method of execution has ever been set aside as unconstitutional, though methods of execution have come and gone — think hanging, firing squad, and electric chair (though this last one may be coming back) — based on public perception of the outward appearance of death by execution.

Administering paralytics and other drugs may make lethal injection look more humane, even peaceful. Yet autopsies performed on individuals executed by lethal injection have shown that they suffered from pulmonary edema — their lungs were drenched with body fluids. In a self-aware person, such lung congestion would be akin to death by drowning.

Society’s opinion about what it finds to be cruel continues to evolve. But it should primarily take into account the sufferer, not those who are watching.

At the bedside of someone who is dying, families and friends are increasingly welcomed to be present, to accompany a loved one in their last moments. This is a good thing, as it returns death and dying to the realm of the home and community so people do not have to die alone. It also helps drive home that death is part of life and not something to hide away or ignore.

The danger that the SILENCE trial presents is the risk that hospitals will curate the dying experience for the sake of loved ones, just as lethal injection curates a medicalized execution for the sake of the witnesses.

If the death rattle is not painful, instead of muting it — and instead of simply paralyzing the executed — it may be better to recognize the bright line that separates the living from the dead. Mollification of observers’ experiences in both instances may anesthetize feelings regarding natural death or killing. It may also lower the bar for what constitutes facilitating death or moral killing.

As a society, we must be sure to uphold our collective humanity and alleviate suffering. But we should be focused on the suffering of the dying and not those who are watching.

Complete Article HERE!

The 11 qualities of a good death

Opening up about death can make it easier for ourselves and our loved ones.

By Jordan Rosenfeld

Nearly nine years ago, I received a call from my stepmother summoning me to my grandmother’s house. At 92 years old, my Oma had lost most of her sight and hearing, and with it the joy she took in reading and listening to music. She spent most of her time in a wheelchair because small strokes had left her prone to falling, and she was never comfortable in bed. Now she had told her caregiver that she was “ready to die,” and our family believed she meant it.

I made it to my grandmother in time to spend an entire day at her bedside, along with other members of our family. We told her she was free to go, and she quietly slipped away that night. It was, I thought, a good death. But beyond that experience, I haven’t had much insight into what it would look like to make peace with the end of one’s life.

A recent study published in the American Journal of Geriatric Psychiatry, which gathered data from terminal patients, family members and health care providers, aims to clarify what a good death looks like. The literature review identifies 11 core themes associated with dying well, culled from 36 studies:

  • Having control over the specific dying process
  • Pain-free status
  • Engagement with religion or spirituality
  • Experiencing emotional well-being
  • Having a sense of life completion or legacy
  • Having a choice in treatment preferences
  • Experiencing dignity in the dying process
  • Having family present and saying goodbye
  • Quality of life during the dying process
  • A good relationship with health care providers
  • A miscellaneous “other” category (cultural specifics, having pets nearby, health care costs, etc.)

In laying out the factors that tend to be associated with a peaceful dying process, this research has the potential to help us better prepare for the deaths of our loved ones—and for our own.

Choosing the way we die

Americans don’t like to talk about death. But having tough conversations about end-of-life care well in advance can help dying people cope later on, according to Emily Meier, lead author of the study and a psychologist who worked in palliative care at the University of California San Diego’s Morres Cancer Center. Her research suggests that people who put their wishes in writing and talk to their loved ones about how they want to die can retain some sense of agency in the face of the inevitable, and even find meaning in the dying process.

Natasha Billawala, a writer in Los Angeles, had many conversations with her mother before she passed away from complications of the neurodegenerative disease ALS (amytropic lateral sclerosis) in December 2015. Both of her parents had put their advanced directives into writing years before their deaths, noting procedures they did and didn’t want and what kinds of decisions their children could make on their behalf. “When the end came it was immensely helpful to know what she wanted,” Billawala says.

When asked if her mother had a “good death,” according to the UCSD study’s criteria, Billawalla says, “Yes and no. It’s complicated because she didn’t want to go. Because she lost the ability to swallow, the opportunity to make the last decision was taken from her.” Her mother might have been able to make more choices about how she died if her loss of functions had not hastened her demise. And yet Billawalla calls witnessing her mother’s death “a gift,” because “there was so much love and a focus on her that was beautiful, that I can carry with me forever.”

Pain-free status

Dying can take a long time—which sometimes means that patients opt for pain medication or removing life-support systems in order to ease suffering. Billawala’s mother spent her final days on morphine to keep her comfortable. My Oma, too, had opiate pain relief for chronic pain.

Her death wasn’t exactly easy. At the end of her life, her lungs were working hard, her limbs twitching, her eyes rolling behind lids like an active dreamer. But I do think it’s safe to say that she was as comfortable as she could possibly be—far more so than if she’d been rushed to the hospital and hooked up to machines. It’s no surprise that many people, at the end, eschew interventions and simply wish to go in peace.

Emotional well-being

Author and physician Atul Gwande summarizes well-being as “the reasons one wishes to be alive” in his recent book Being Mortal. This may involve simple pleasures like going to the symphony, taking vigorous hikes or reading books He adds: “Whenever serious sickness or injury strikes and your body or mind breaks down … What are the trade-offs you are willing to make and not willing to make?”

Kriss Kevorkian, an expert in grief, death and dying, encourages those she educates to write advance directives with the following question in mind: “What do you want your quality of life to be?”

The hospital setting alone can create anxiety or negative feelings in an ill or dying person, so Kevorkian suggests family members try to create a familiar ambience through music, favorite scents, or conversation, among other options, or consider whether it’s better to bring the dying person home instead. Billawalla says that the most important thing to her mother was to have her children with her at the end. For many dying people, having family around can provide a sense of peace.

Opening up about death and dying

People who openly talk about death when they are in good health have a greater chance of facing their own deaths with equanimity. To that end, Meier is a fan of death cafés, which have sprung up around the nation. These informal discussion groups aim to help people get more comfortable talking about dying, normalizing such discussions over tea or cake. It’s a platform where people can chat about everything from the afterlife (or lack thereof) to cremation to mourning rituals.

Doctors and nurses must also confront their own resistance to openly discussing death, according to Dilip Jeste, a coauthor of the study and geriatric psychiatrist with the University of California San Diego Stein Institute for Research on Aging. “As physicians we are taught to think about how to prolong life,” he says. That’s why death becomes [seen as] a failure on our part.” While doctors overwhelmingly believe in the importance of end-of-life conversations, a recent US poll found that nearly half (46%) of doctors and specialists feel unsure about how to broach the subject with their own patients. Perhaps, in coming to a better understanding of what a good death looks like, both doctors and laypeople will be better prepared to help people through this final, natural transition.

Complete Article HERE!

Planning your funeral doesn’t have to be scary, says the author of ‘It’s Your Funeral: Plan the Celebration of a Lifetime Before it’s Too Late’

By

The pandemic has forced many to rethink and readjust their present with their future. Some have left jobs that provided steady paychecks and a predictable complacency for unknown, yet meaningful passion projects. Others are are taking more control of their destinies as they see fit. Unwilling to settle in life anymore. So why would you settle in death?

That’s the question Kathy Benjamin, author of “It’s Your Funeral! Plan the Celebration of a Lifetime — Before it’s Too Late,” asks. Amid the book’s 176 pages, Benjamin exposes readers to death in a light, humorous, and practical way, akin to a soothing bath, rather than a brisk cold shower.

The Austin-based writer’s niche is death (her last book centered on bizarre funeral traditions and practices). Having panic attacks as a teen, Benjamin said enduring them felt like she was dying. It was then that she started wrestling with the idea of death.

“I feel like I’m actually dying all the time, so maybe I should learn about the history of death and all that,” she said. “If I’m going to be so scared of it, I should learn about it because then I’d kind of have some control over it.”

It’s that control that Benjamin wants to give to readers of this book. She introduces readers to concepts and steps one should contemplate now, in order to make sure the last big gathering centered on you is as memorable as you and your loved ones wish. Poring over the book, one finds interesting final resting options such as body donation that goes beyond being a medical cadaver, “infinity burial suits” that lets one look like a ninja at burial, but also helps nourish plants as decomposition begins; and quirky clubs and businesses that allow one to make death unique (as in hiring mourners to fill out your grieving space and time, and designing your own coffin).

Kathy Benjamin knows death can be scary, but she's determined to show that planning your own funeral doesn't have to be.
Kathy Benjamin knows death can be scary, but she’s determined to show that planning your own funeral doesn’t have to be.

Now before you think this is all a bit macabre, Benjamin’s book also serves as a personal log so you can start planning your big event. Amid the pages, she offers prompts and pages where you can jot down thoughts and ideas on fashioning your own funeral. If you want to have a theme? Put it down in the book. You want to start working on your eulogy/obituary/epitaph, will, or your “final” playlist? Benjamin gives you space in her book to do so. It’s like a demise workbook where you can place your best photos to be used for the funeral and your passwords to your digital life, for your loved ones to have access to that space once you’re gone. If all the details are in the book, a loved one just has to pick it up and use it as a reference to make sure your day of mourning is one you envisioned.

As Benjamin writes: “Think about death in a manner that will motivate you to live the best, most fulfilling life possible. By preparing for death in a spiritual and physical way, you are ensuring that you will succeed right to the end.”

“Everyone’s going to die, if you’re willing to be OK with thinking about that, and in a fun way, then the book is for you,” she said.

We talked with Benjamin to learn more about the details of death and thinking “outside the coffin” for posterity’s sake. The following interview has been condensed and edited.

‘It’s Your Funeral! Plan the Celebration of a Lifetime — Before it’s Too Late’ is by Kathy Benjamin, Quirk Books, 176 pages, $14.40.
‘It’s Your Funeral! Plan the Celebration of a Lifetime — Before it’s Too Late’ is by Kathy Benjamin, Quirk Books, 176 pages, $14.40.

Q: How much time did it take you to find all this data about death? You share what was in the late Tony Curtis’ casket.

Kathy Benjamin: I have shelves of books that range from textbooks to pop culture books about death, and it’s something that a lot more people than you think are interested in so when you start doing online research you might just find a list of, here’s what people have in their coffin and then from there, you’re like: ‘OK, let’s check if this is true.’ Let’s go back and check newspaper articles and more legitimate websites and things and those details are out there. People want to know. I think of it as when you see someone post on Facebook — somebody in my family died. I know for me, and based on what people reply, the first thing is: What did they die of? We want these details around death. It’s just something people are really interested in. The information is out there and if you go looking for it, you can find it.

Q: Was the timing for the release of the book on point or a little off, given the pandemic?

KB: That was unbelievable timing, either good or bad, how you want to look at it. I ended up researching and writing during that whole early wave in the summer (2020) and into the second wave, and it was very weird. It was very weird to wake up, and the first thing I would do every morning for months was check how many people were dead and where the hot spots were, and then write … just a lot of compartmentalization. My idea was because people who were confronting death so much, maybe it would open up a lot of people’s minds who wouldn’t normally be open to reading this kind of book, they’d be like: ‘OK, I’ve faced my mortality in the past year. So actually, maybe, I should think about it.’

Q: Is there anything considered too “out there” or taboo for a funeral?

KB: I always think that funerals really are for the people who are still alive to deal with their grief, so I wouldn’t do anything that’s going to offend loved ones. I can’t think of what it might be, but if there’s a real disagreement on what is OK, then maybe take the people who are going to be crying and keep them in mind. But really, it’s your party. Plan what you want. There are so many options out there. Some people, they still think cremation isn’t acceptable. Because death is so personal, there’s always going to be people who think something is too far, even things that seem normal for your culture or for your generation.

Q: You mention some interesting mourning/funeral businesses, but many seem to be in other countries. Do we have anything cool in the U.S. as far as death goes that maybe other places don’t have?

KB: One thing we have more than anywhere in the world is body farms. We have a couple and just one or two in the entire rest of the world. The biggest in the world is at the University of Tennessee. For people who don’t know, body farms are where you can donate your body as if you would to science, but instead of doing organ transplants or whatever with it, they put you in the trunk of a car or they put you in a pond or they just lay you out and then they see what happens to you as you decompose. Law enforcement recruits come in and study you to learn how to solve crimes based on what happens to bodies that are left in different situations. I think they get about 100 bodies a year. I always tell people about body farms because if you’re into “true crime” and don’t care what happens to you and you’re not grossed out by it, then do it because it’s really cool and it’s helpful.

Q: You mention mummification and traditional Viking send offs, what about the burning of a shrouded body on a pyre? Have you heard about that? It was the way hunters were sent into the afterlife on the TV series “Supernatural.”

KB: I haven’t heard of anyone doing it in America but obviously that’s a big pop culture thing. For Hindus, that’s the way it happens in India … you go to the Ganges, and they have places specifically where you pay for the wood and they make a pyre and that’s how people go out. I doubt there’s a cemetery or a park that would allow you to do it in the U.S., but on private land, you’re pretty much allowed to do whatever. I would definitely check on regulations. You would have to get the pyre quite hot to burn the body to ash, like hotter than you think to make sure you don’t get a barbecued grandpa.

Q: In your research, have you come across anything that completely surprised you because it’s so unheard of?

KB: There’s been things like funerary cannibalism, which is where you eat loved ones after they’ve died. But once you’ve read the reasons why different tribes around the world have done it, you’re like ‘OK, I can see why that meant something, why it was meant to be emotional and beautiful.’ Things like sky burial in Tibet, they have a Buddhist monk chop up the body and lay it out for the vultures to come get. Part of it ties back to Buddhist tradition but also it’s Tibet, you can’t dig holes there in the mountains. So, there’s a logical reason for it. When you look at these things that originally seem gross or weird, once you learn the reasons behind them it all comes back in the end to trying to do something respectful for the dead, and trying to give the living that closure.

Q: What are your plans for your funeral?

KB: I definitely want to be cremated. I don’t know if I want people to necessarily come together for a funeral for me but like I have a playlist, and even before the book I had a whole document on the computer of what I wanted. I want all the people to know about the playlist and then they can kind of sit and think about how awesome I am while the sad songs play, and then there’s different places that I would want my ashes scattered.

Complete Article HERE!

Why Some Scientists Think Consciousness Persists After Death

We should not assume that people who are near death do not know what we are saying

By News

A very significant change that happened in the last century or so has been the ability of science professionals to see what happens when people are thinking, especially under traumatic conditions.

It was not a good moment for materialist theories. Here is one finding (there are many others): Death is a process, usually, not simply an event.

Consciousness can persists after clinical death. A more accurate way of putting things might be that the brain is able to host consciousness for a short period after clinical death. Some notes on recent findings:

The short answer is, probably, yes:

Recent studies have shown that animals experience a surge in brain activity in the minutes after death. And people in the first phase of death may still experience some form of consciousness, [Sam] Parnia said. Substantial anecdotal evidence reveals that people whose hearts stopped and then restarted were able to describe accurate, verified accounts of what was going on around them, he added.

“They’ll describe watching doctors and nurses working; they’ll describe having awareness of full conversations, of visual things that were going on, that would otherwise not be known to them,” he explained. According to Parnia, these recollections were then verified by medical and nursing staff who were present at the time and were stunned to hear that their patients, who were technically dead, could remember all those details.

Mindy Weisberger, “Are ‘Flatliners’ really conscious after death?” at LiveScience (October 4, 2017)

Death is probably, in most cases, a process rather than a single event:

Time of death is considered when a person has gone into cardiac arrest. This is the cessation of the electrical impulse that drive the heartbeat. As a result, the heart locks up. The moment the heart stops is considered time of death. But does death overtake our mind immediately afterward or does it slowly creep in?

Some scientists have studied near death experiences (NDEs) to try to gain insights into how death overcomes the brain. What they’ve found is remarkable, a surge of electricity enters the brain moments before brain death. One 2013 study out of the University of Michigan, which examined electrical signals inside the heads of rats, found they entered a hyper-alert state just before death.

Philip Perry, “After death, you’re aware that you’ve died, say scientists” at BigThink (October 24, 2017)

Despite claims, current science does not do a very good job of explaining human experience just before death:

Researchers have also explained near-death experiences via cerebral anoxia, a lack of oxygen to the brain. One researcher found air pilots who experienced unconsciousness during rapid acceleration described near-death experience-like features, such as tunnel vision. Lack of oxygen may also trigger temporal lobe seizures which causes hallucinations. These may be similar to a near-death experience.

But the most widespread explanation for near-death experiences is the dying brain hypothesis. This theory proposes that near-death experiences are hallucinations caused by activity in the brain as cells begin to die. As these occur during times of crisis, this would explain the stories survivors recount. The problem with this theory, though plausible, is that it fails to explain the full range of features that may occur during near-death experiences, such as why people have out-of-body experiences.

Neal Dagnall and Ken Drinkwater, “Are near-death experiences hallucinations? Experts explain the science behind this puzzling phenomenon” at The Conversation (December 4, 2018)

Such explanations are a classic case of adapting a materialist hypothesis to fit whatever has happened. They don’t explain, for example, terminal lucidity, where many people suddenly gain clarity about life.

Research medic Sam Parnia found, for example, that, of 2000 patients with cardiac arrest,

Some died during the process. But of those who survived, up to 40 percent had a perception of having some form of awareness during the time when they were in a state of cardiac arrest. Yet they weren’t able to specify more details.

Cathy Cassata, “We May Still Be Conscious After We Die” at Healthline (September 24, 2018) The paper requires a subscription.

So we should not assume that people who are on the way out cannot understand us. Maybe they can — and would like to hear that they are still loved and will be missed.

Complete Article HERE!

Why Americans Die So Much

U.S. life spans, which have fallen behind those in Europe, are telling us something important about American society.

By Derek Thompson

America has a death problem.

No, I’m not just talking about the past year and a half, during which COVID-19 deaths per capita in the United States outpaced those in similarly rich countries, such as Canada, Japan, and France. And I’m not just talking about the past decade, during which drug overdoses skyrocketed in the U.S., creating a social epidemic of what are often called “deaths of despair.”

I’m talking about the past 30 years. Before the 1990s, average life expectancy in the U.S. was not much different than it was in Germany, the United Kingdom, or France. But since the 1990s, American life spans started falling significantly behind those in similarly wealthy European countries.

According to a new working paper released by the National Bureau of Economic Research, Americans now die earlier than their European counterparts, no matter what age you’re looking at. Compared with Europeans, American babies are more likely to die before they turn 5, American teens are more likely to die before they turn 20, and American adults are more likely to die before they turn 65. At every age, living in the United States carries a higher risk of mortality. This is America’s unsung death penalty, and it adds up. Average life expectancy surged above 80 years old in just about every Western European country in the 2010s, including Portugal, Spain, France, Italy, Germany, the U.K., Denmark, and Switzerland. In the U.S., by contrast, the average life span has never exceeded 79—and now it’s just taken a historic tumble.

Why is the U.S. so much worse than other developed countries at performing the most basic function of civilization: keeping people alive?

“Europe has better life outcomes than the United States across the board, for white and Black people, in high-poverty areas and low-poverty areas,” Hannes Schwandt, a Northwestern University professor who co-wrote the paper, told me. “It’s important that we collect this data, so that people can ask the right questions, but the data alone does not tell us what the cause of this longevity gap is.”

Finding a straightforward explanation is hard, because there are so many differences between life in the U.S. and Europe. Americans are more likely to kill one another with guns, in large part because Americans have more guns than residents of other countries do. Americans die more from car accidents, not because our fatality rate per mile driven is unusually high but because we simply drive so much more than people in other countries. Americans also have higher rates of death from infectious disease and pregnancy complications. But what has that got to do with guns, or commuting?

By collecting data on American life spans by ethnicity and by income at the county level—and by comparing them with those of European countries, locality by locality—Schwandt and the other researchers made three important findings.

First, Europe’s mortality rates are shockingly similar between rich and poor communities. Residents of the poorest parts of France live about as long as people in the rich areas around Paris do. “Health improvements among infants, children, and youth have been disseminated within European countries in a way that includes even the poorest areas,” the paper’s authors write.

But in the U.S., which has the highest poverty and inequality of just about any country in the Organization for Economic Cooperation and Development, where you live is much more likely to determine when you’ll die. Infants in the U.S. are considerably more likely to die in the poorest counties than in the richest counties, and this is true for both Black and white babies. Black teenagers in the poorest U.S. areas are roughly twice as likely to die before they turn 20, compared with those in the richest U.S. counties. In Europe, by contrast, the mortality rate for teenagers in the richest and poorest areas is exactly the same—12 deaths per 100,000. In America, the problem is not just that poverty is higher; it’s that the effect of poverty on longevity is greater too.

Second, even rich Europeans are outliving rich Americans. “There is an American view that egalitarian societies have more equality, but it’s all one big mediocre middle, whereas the best outcomes in the U.S. are the best outcomes in the world,” Schwandt said. But this just doesn’t seem to be the case for longevity. White Americans living in the richest 5 percent of counties still die earlier than Europeans in similarly low-poverty areas; life spans for Black Americans were shorter still. (The study did not examine other American racial groups.) “It says something negative about the overall health system of the United States that even after we grouped counties by poverty and looked at the richest 10th percentile, and even the richest fifth percentile, we still saw this longevity gap between Americans and Europeans,” he added. In fact, Europeans in extremely impoverished areas seem to live longer than Black or white Americans in the richest 10 percent of counties.

Third, Americans have a lot to learn about a surprising success story in U.S. longevity. In the three decades before COVID-19, average life spans for Black Americans surged, in rich and poor areas and across all ages. As a result, the Black-white life-expectancy gap decreased by almost half, from seven years to 3.6 years. “This is a really important story that we ought to move to the forefront of public debate,” Schwandt said. “What happened here? And how do we continue this improvement and learn from it?”

One explanation begins with science and technology. Researchers found that nothing played bigger roles in reducing mortality than improvements in treating cardiovascular disease and cancer. New drugs and therapies for high cholesterol, high blood pressure, and various treatable cancers are adding years or decades to the lives of millions of Americans of all ethnicities.

Policy also plays a starring role. Schwandt credits the Medicaid expansion in the 1990s, which covered pregnant women and children and likely improved Black Americans’ access to medical treatments. He cites the expansion of the earned-income tax credit and other financial assistance, which have gradually reduced poverty. He also points to reductions in air pollution. “Black Americans have been more likely than white Americans to live in more-polluted areas,” he said. But air pollution has declined more than 70 percent since the 1970s, according to the EPA, and most of that decline happened during the 30-year period of this mortality research.

Other factors that have reduced the Black-white life-expectancy gap include the increase in deaths of despair, which disproportionately kill white Americans, and—up until 2018—a decline in homicides, which disproportionately kill Black Americans. (The recent rise in homicides, along with the disproportionate number of nonwhite Americans who have died of COVID-19, will likely reduce Black life spans.)

Even then, Black infants in high-poverty U.S. counties are three times more likely to die before the age of 5 than white infants in low-poverty counties. But Schwandt insists that highlighting our progress is important in helping us solve the larger American death problem. “We are wired to care more about bad news than about good news,” he said. “When life expectancy rises slightly, nobody cares. But when life expectancy declines, suddenly we’re up in arms. I think that’s a tragedy, because to improve the health and well-being of our populations, and especially of our disadvantaged populations, we have to give attention to positive achievements so that we can learn from them.”

We’re a long way from a complete understanding of the American mortality penalty. But these three facts—the superior outcomes of European countries with lower poverty and universal insurance, the equality of European life spans between rich and poor areas, and the decline of the Black-white longevity gap in America coinciding with greater insurance protection and anti-poverty spending—all point to the same conclusion: Our lives and our life spans are more interconnected than you might think.

For decades, U.S. politicians on the right have resisted calls for income redistribution and universal insurance under the theory that inequality was a fair price to pay for freedom. But now we know that the price of inequality is paid in early death—for Americans of all races, ages, and income levels. With or without a pandemic, when it comes to keeping Americans alive, we really are all in this together.

Complete Article HERE!

More people are dying at home, but the quality of their deaths matters most

Did they receive care and compassion from loved ones or did they die alone, fearful of getting infected in hospital?

By and

From the start of the pandemic to 24 September 2021, deaths at home in England and Wales have been 37% higher than the 2015-2019 average, according to the Office for National Statistics.

For every three people who used to die at home, four now do. That’s more than 71,000 “excess” deaths, only 8,500 of which involved Covid. Even as mortality elsewhere fell back to past levels, dying in private homes has persistently remained above average. A natural question arises: are these “extra” deaths or a shift from other locations?

Fortunately, National Records of Scotland publishes excess death calculations by location and major causes of death. Its most recent data shows the leading causes of death were cancer, heart disease and stroke. In 2021, the combined total for these causes was only about 1% above the 2015-2019 average, with around 260 extra deaths. However, deaths from these causes at home were 36% higher than recent years, with a corresponding decrease in care homes and hospitals. These additional deaths at home were not “extra”, but resulted from a major, systematic change in where people were dying.

So what’s the reason for this change and, perhaps more importantly, what was the quality of these deaths? How many were free of pain and experienced intimate care and compassion from loved ones and how many have died at home alone, fearful of getting infected in hospital? Existing statistics struggle to answer these important questions.

NHS England has sought to “personalise” end-of-life care in its long-term plan. Reported statistics from surveys and patient records about where people wish to die can exclude “missing” responses, such as when no preference is forthcoming. It is unclear if the shift towards dying at home is, on balance, a positive or negative development.

Every family has to deal with a death and live with its aftermath. In the words of Sam Royston, director of policy and research at Marie Curie: “It is critical that we ensure that those who die at home have all of the support and assistance they need for the best possible death.”

Complete Article HERE!

Death’s Price Tag: An inevitable trauma

By Judas Cote

In the spirit of October, I figured I should speak on a topic I’m passionate about, as someone considering end-of-life care as a career (I gag at the connotation of making a career of death care, but such is the nature of capitalism): the funeral industry. Let that phrase sink in for a second: Funeral. Industry. Death that generates financial capital. Death, a necessary and inevitable part of the human experience, costs and generates money.

Death is a tough subject, and for good reason. It’s a reminder of all of our mortalities, and that’s a lot to be confronted with, especially considering how capitalism makes us proletarians believe that we’re inhuman, that we’ll simply be exploited for an indeterminate amount of time, and then disappear from relevance. This alienation from mortality and personhood diminishes the depth of life brought about by our own mortality, and then, once confronted with it, the capitalist robo-proletarian illusion shatters, bringing great distress but no room to heal from it due to the standard 9 to 5 workday and low wages.

Let me step back and explain what I mean by this though. Many people work some variation of an eight hour shift job. If they’re full time, that’s about 40 hours per week, sometimes more, which leaves one or two days off. The Ford model of the work day is supposed to be eight hours of work, eight hours of leisure, and eight hours of rest. This treats human needs as if they were easy to standardize. It takes no account for commutes, obtaining and preparing food, the amount of sleep an individual needs to function, or difference of ability as this does vary widely in the working population. Some people forfeit another one of these eight hour blocks, working two jobs to make ends meet. How much time does that leave for the necessities: nourishment and sleep? Not much. How much time does that leave for self-actualization? Barely any. So how much time does that leave to process grief specifically? Almost none. Capitalism forces us to go about our lives broken and exploited, many without the means to mend our psyches due to the high cost of mental healthcare (and healthcare in general).

Funerals with bodies are considered the standard of funerary action in the United States. Between the funeral ceremony and the embalming/preservation of the body, costs can surge to thousands of dollars just to make this arbitrary ceremony.

Now to the funeral industrial complex. Think for a minute—what would you consider a dignified burial for a loved one who left behind no death plan? Maybe cremation, maybe burial in a casket, but not much else. Cremation is the cheaper option, and embalmed casket burials are often expensive. Not only do they take into account the labor from the funeral home for a service, but also the labor of embalming (which is widely overused in the United States due to its popularity in the Civil War for the transport of the bodies of soldiers) and the price of the casket and headstone. Caskets run around $1,200, give or take, and funeral homes often mark them up to generate profit. Headstones vary widely but can run from around $65 to over $200 . This doesn’t take into account any markups from manufacturers either. Plots can run around $350 to $5,000, embalming costs upwards of $500. Add in flowers and concessions and you get an idea as to why traditional American funerals are so expensive.

So, I would like to talk about some alternatives. Firstly, there’s donating your corpse to science (which is my plan). This involves one’s body being brought to whatever scientific institution needs cadavers (medical schools mainly) for educational use, and then discarded in mass graves afterwards. There are no direct costs with this approach, but you can always hold a service for a loved one who donates their body, just without their cadaver. There’s also natural burial, either in a plain shroud or one with a seed pod. Connecticut has multiple natural burial grounds around the state. Better Place Forests prices ceremonies based on the memorial tree you want, starting at around $5,900 for the cheapest option. Depending on the grounds you choose, prices will vary, and without a tree the burial would be cheaper as well. Other options include Aquamation (which is legal for humans and pets in Connecticut, for those concerned with eco-friendliness) and feed blocks (mixing cremated remains into feed blocks for woodland animals).

So, what changes do I think need to be made?

I think that funerary and end of life care should cease to be an industry; just as medicine, infrastructure, internet, plumbing and the like should cease to be industries. A shift in governmental values from those serving the class with the highest accumulation of capital to serving the working class. A shift towards democracy centered on proletarian needs. A shift to a human collective-centered culture, rather than a profit-centered one. Replace dog-eat-dog with camaraderie. Truly place power in the hands of the people, and build a world of collaboration and healing.

Complete Article HERE!