Category: Talking about death

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The Difficult Business of Dying

The U.S. funeral industry is the most expensive and corporate in the world. Can Americans find a better way to grieve?

By Jess Bergman

[I]n the six years since my father died, I’ve visited the cemetery where his ashes are interred exactly twice—the second time only because of the Jewish tradition of unveiling, where the initial graveside funeral service is followed within a year by a ceremony to uncover and dedicate the headstone. It’s not that returning would be too difficult. It’s more like the reverse: I fear an inability to perform the sadness and solemnity the pilgrimage seems to require. I miss my dad, but the cemetery, nestled alongside the highways and strip malls of suburban South Jersey, fails to evoke him in any meaningful way. It’s a site associated with him only retroactively, for the worst of all possible reasons. Where I’m supposed to feel his presence, there’s only a void.

FROM HERE TO ETERNITY: TRAVELING THE WORLD TO FIND THE GOOD DEATH by Caitlin Doughty

Los Angeles-based mortician and writer Caitlin Doughty argues that such feelings result from the failures of America’s death industry, which has become “more expensive, more corporate, and more bureaucratic than any other on Earth.” According to the National Funeral Directors’ association, the median cost of traditional funeral with a viewing and burial was $7,181 in 2014; Doughty cites the current average at $8,000 to $10,000. 14 percent of US funeral homes are run by publicly traded firms. Service Corporation International, the largest funeral services provider in the US, operates over 2,000 funeral homes employing more than 24,000 people. The $20-billion industry often pushes grief to the margins by pressuring families to make a series of high-stakes decisions on a very short timeline—most funeral homes come to pick up a body within an hour of being contacted.

In some cases, funeral homes deliberately exploit families for financial gain at a time of profound vulnerability. A 2013 undercover investigation conducted by the Federal Trade Commission revealed that up to one in five American funeral homes engage in “deceptive and manipulative practices.” The offenders violated the 1984 Funeral Rule, which stipulates that funeral homes must provide itemized price lists. The compulsory bundling of products and services is prohibited: They can’t require that you buy a traditional varnished casket when all you want is a cremation; an inexpensive, unfinished wooden box must be made available. And the law bans the aggressive sale of products that are not required by law, like the use of a hearse to transport remains to a cemetery. Though most funeral homes keep dedicated websites, few display their prices online, which makes it challenging to compare costs.

With its focus on profits, the industry has also changed the way we treat dead bodies. As recently as a hundred years ago, “no one would have questioned a wife washing and dressing the body of her husband,” Doughty writes, “or a father carrying his son to the grave in a homemade coffin.” The Civil War is often identified as the point at which practices began to shift. Embalming became more common as soldiers’ bodies were transported from the South to the North. It gained even more popularity after Abraham Lincoln’s funeral train tour, which took his embalmed corpse to 180 cities between Washington D.C. and Springfield, Illinois. Now, the United States is the only country in the world in which chemical conservation of the dead is common practice—a process that can cost anything from $495 to over $1,000. What was once a practical solution with a historically specific context has become a profitable norm, despite, according to the CDC, providing no public health benefit.

In her book From Here to Eternity: Traveling the World to Find the Good Death, Doughty tries to find a better way to die and to grieve, seeking out death rituals from the Western United States to Japan, Spain, Indonesia, and beyond. It sounds a bit like Eat, Pray, Die, but her project is much larger than its premise first implies. She is searching not for personal spiritual enlightenment or the morbid titillation of thana-tourism, but for practical, radical alternatives to our corporatized death industry. Her travels illuminate a host of compelling possibilities for better funerals and a less fraught relationship with our dead. But the book also reveals a larger failure of our culture to allow for mourning and grieving after the last goodbye. If it is hard to navigate the death care industry, it is harder still to work out how to live with grief.

On her travels, Doughty finds many rituals that involve prolonged contact with corpses—prolonged, at least, by American standards. All around the world, she meets people less troubled by the physical reality of dead bodies, whether those bodies are burned to ash, mummified, “decomposting,” or lying under glass in their natural, un-embalmed state. In Japan she visits a corpse hotel where families may rent a suite that looks like an ordinary condo and “just be with the body, free from the performance required at a formal viewing.” And at the Rinkai crematory, Doughty learns about the practice of kotsuage. According to this custom, families are escorted into a room called a shūkotsu-shitsu after a cremation, where they pick up their loved one’s remaining bone fragments and place them gently into an urn.

In North Carolina, Doughty spends time at Western Carolina University’s Forensic Osteology Research Station (FOREST), where corpses donated to science are turned into compost. The bodies are laid to rest in a wooded research facility, blanketed with alfalfa and woodchips, covered in a silver shroud, and in the hot sun to turn into dark, nutrient-rich soil after a period of weeks. The project is still in its experimental phase, but the FOREST researchers hope it will become a green solution with a therapeutic arc. Families will ultimately be invited to collect the soil made from the body of their loved one and with it, cultivate new life.

Doughty finds her most extreme example of dead body positivity in Tana Toraja in Indonesia. For Torajans, the border between the living and the dead is porous. Corpses frequently remain in the home for a period of weeks, months, or even years, and are cared for like any other member of the family—bathed, fed, dressed, and spoken to. After they are finally buried, following elaborate community funerals, bodies are periodically exhumed during what is called the ma’nene’. Families have the opportunity to reunite, and even picnic, with their dead; they can make animal sacrifices they may not have been able to afford at the time of the original burial. What sounds grisly to some is, to the Torajans, both tender and sacred: “Hauling someone out of their grave years after their death is not only respectful,” Doughty writes, “but it provides a meaningful way to stay connected to their dead.”

Doughty’s chatty calm in the presence of dead bodies and her arguments against American squeamishness are admirable. But it feels, at times, like From Here to Eternity’s focus on death comes at the expense of grief. This is not a failure of the project so much as its shape; the nature of Doughty’s inquiry makes grief a secondary concern. It does appear sporadically: In the chapter on the Day of the Dead, she travels to Mexico with her friend Sarah to visit a mummy museum, as well as the altars families erect to honor the people they’ve lost that year. Sarah is still reeling from the decision to obtain a late-term abortion when her fetus was diagnosed with trisomy 13, and Doughty writes about the isolation of Sarah’s grief, her feeling that the inability to move on from the loss had made her “radioactive” to her friends and coworkers. Her loss, and the future she had imagined, is devastatingly rendered. There is a digression, too, on the Western funeral industry’s fixation on “dignity,” by which they really mean silence, composure, and repression—this, too, is a moment of genuine feeling, and Doughty shows that though her tone is often light, she has the capacity to move and enrage.

But just as often, Doughty fails to engage with the realities of mourning. At an open-air cremation she attends in Crestone, Colorado, she professes to witness the “pall of grief [lifting] from the circle.” I don’t doubt the power of this ceremony. But the implication that it was able to dispel sadness—that such a thing is possible, or even desirable, at a funeral—gives me pause. Worse, in the book’s epilogue, she writes, “A sense of purpose helps the mourner grieve. Grieving helps the mourner begin to heal.” This is a neat, linear progression; in other words, it’s exactly what the experience of grief is not.

There is more to death and dying than funerals. From Here to Eternity is in some ways a missed opportunity to explore how the profit motive has distorted our experience of death—not just burial, but all the feeling that comes after a body is buried. In The Last Word, Julia Cooper writes of the difficulty of grieving under late capitalism. The amorphous, endless, and unpredictable nature of grief puts it fundamentally at odds with pressures “to be efficient, to progress, to—most of all—get back to work.” But, she writes, “mourning doesn’t work that way. There is no timeline because the work of grieving is never done. There is nothing efficient or productive about loss, but there it is all the same.” Grieving is the enemy of work, and we’re expected to suppress the former in the interest of the latter.

Minimizing the pain of personal loss, Cooper argues, is in service of “maintaining productivity for the benefit of a capitalist system.” Public displays of grief are shunned in part because they undermine the relentless positivity our economic system feeds on. The isolation of those who are unable to successfully curb their mourning is “a socially enforced strategy of our neoliberal era.” The repression of grief is also materially enforced: The standard paid bereavement leave, where it does exist, is three days. At Facebook, COO and Lean In author Sheryl Sandberg changed the company’s bereavement policy following the sudden death of her husband in 2015; the company now offers employees a comparatively generous 20 days paid leave following the loss of an immediate family member.

In the op-ed Sandberg wrote for The New York Times about her children’s experience of bereavement, she talks about grief in the language of business. The death of a parent is “adversity”; the word “resilience” is used six times, while “grieving” makes one appearance. Sandberg writes of her son and daughter’s loss (and her own) alongside the story of a friend’s child who was bullied at summer camp, with the implication that both experiences can be “overcome” with the same set of therapeutic tools. Sandberg’s approach isn’t insincere; original or not, the idea that “there is no wrong way to grieve” is an important one. But for those who don’t find this way of thinking helpful, our culture offers few other ways to address grief and work.

Caitlin Doughty’s mission to reimagine the death industry—to cast out our shame and fear of the dead—is an important one, for which she makes the case well and with good humor. More humane and meaningful rituals around death would doubtless ease the transition into the new reality that awaits the living after a traumatic loss. For my part, I look forward to one day spreading what I’ve kept of my father’s ashes, at a site less dour than a New Jersey tomb. But reforming our funeral industrial complex is only the beginning of the work ahead of us.

Complete Article ↪HERE↩!

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Most people want to die at home, but many land in hospitals getting unwanted care

 

By Andrew MacPherson and Ravi B. Parikh

[W]here do you want to die? When asked, the vast majority of Americans answer with two words: “At home.”

Despite living in a country that delivers some of the best health care in the world, we often settle for end-of-life care that is inconsistent with our wishes and administered in settings that are unfamiliar, even dangerous. In California, for example, 70 percent of individuals surveyed said they wish to die at home, yet 68 percent do not.

Instead, many of us die in hospitals, subject to overmedication and infection, often after receiving treatment that we do not want. Doctors know this, which may explain why 72 percent of them die at home.

Using data from the Dartmouth Atlas — a source of information and analytics that organizes Medicare data by a variety of indicators linked to medical resource use — we recently ranked geographic areas based on markers of end-of-life care quality, including deaths in the hospital and number of physicians seen in the last year of life. People are accustomed to ranking areas of the country based on availability of high-quality arts, universities, restaurants, parks and recreation and health-care quality overall. But we can also rank areas based on how they treat us at an important moment of life: when it’s coming to an end.

It turns out not all areas are created equal. Critical questions abound. For example, why do 71 percent of those who die in Ogden, Utah, receive hospice care, while only 31 percent do in Manhattan? Why is the rate of deaths in intensive care units in Cedar Rapids, Iowa, almost four times that of Los Angeles? Why do only 12 percent of individuals in Sun City, Ariz., die in a hospital, while 30 percent do in McAllen, Texas?

Race and other demographics in a given area certainly matter. One systematic review of more than 20 studies showed that African American and Hispanic individuals utilize advance-care planning and hospice far less than whites. More research is needed to explore these differences and to close these gaps and demand high-quality, personalized care for people of all races.

But race and demographics don’t provide all the answers. For instance, Sarasota and St. Petersburg, Fla., are only 45 miles apart and have similar ethnic demographics. Yet we found that they score quite differently on several key quality metrics at the end of life.

A variety of factors probably contribute to our findings. Hospice, which for 35 years has provided team-based care, usually at home, to those nearing the end of life and remains enormously successful and popular, is under­utilized. Most people enroll in hospice fewer than 20 days before death, despite a Medicare benefit that allows patients to stay for up to six months. Hospice enrollment has been shown to be highly dependent on the type of doctor that you see. In fact, one study among cancer patients with poor prognoses showed that physician characteristics (specialty, experience with practicing in an inpatient setting, experience at hospitals, etc.) mattered much more than patient characteristics (age, gender, race, etc.) in determining whether patients enrolled in hospice. For example, oncologists and doctors practicing at nonprofit hospitals were far more likely than other doctors to recommend hospice.

Also, physicians in a given geographic area are likely to have similar approaches to health care. They may collectively differ from physicians in another area in their familiarity and comfort with offering hospice care to a patient. This may explain why hospice enrollment significantly varies among geographic regions.

Palliative care, which focuses on alleviation of suffering, is often misunderstood by doctors as giving up. Health professionals’ lack of longitudinal, substantive training in end-of-life care only compounds the problem.

Perhaps most important, fewer than half of Americans have had a conversation about their end-of-life wishes — a process known as advance care planning — and only one-third have expressed those wishes in writing for a health-care provider to follow when they become seriously ill. If people do not have a clear sense of their end-of-life wishes, it is easy to imagine that they may be swayed by a physician’s recommendation.

The private sector has led the way in addressing the under­utilization of hospice and improving end-of-life care. For instance, health insurers such as Aetna have devised programs integrating nurse-led case management services for seriously ill individuals, reducing costly and undesired emergency room visits while increasing appropriate hospice referrals. And start-ups including Aspire Health are working with communities to provide palliative care in people’s homes while devising algorithms to help payers and providers identify individuals who might benefit from palliative and hospice care.

Congress also is considering bipartisan solutions consistent with best practices. Congressional leaders have recently introduced several pieces of legislation that would test new models of care for those facing advanced illness, support health professionals in training for end-of-life care and ensure that barriers are removed for consumers to access care.

And Medicare, via its Innovation Center, has led the way in testing promising care models to support those at the end of life, including the Medicare Care Choices Model, which allows individuals to receive hospice care alongside traditional, curative treatment.

But the secret sauce may be a shift in culture. We will not improve the death experience until we demand that our public- and private-sector leaders act and that our local health professionals encourage person-centered end-of-life care.

As with any social change, progress will be driven by a growing awareness and a desire for justice among families and patients. There are good and bad places to die in America. However, to ensure a better death for all, we must confront not just geographic disparities but also our resistance to thinking about death.

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SARCO CAPSULE: Check Out This State-Of-The-Art Suicide Machine

“Sarco does not use any restricted drugs”

By Paul Bois

[O]nce upon a time, people in Western society would invest their time into developing ways to heal people, enrich their lives, and restore their bodies to natural law. Now, we invent sleek new machines for people to commit suicide with.

According to LifeNews, the new “Sarco capsule” from Australia’s top euthanasia activist, offers people a fresh and easy new way to kill themselves without the presence of any doctor.

“The machine will allow anyone who has the access key to end their life by simply pressing a button,” reports LN. “Developed in the Netherlands by Nitschke and an engineer, the machine can be 3D printed and assembled in any location.”

After taking an online mental questionnaire, people are then provided with a four-digit access code to help build the Sarco capsule. Here’s how it works: people wishing to go into the great beyond will lie inside the capsule which will then slowly deplete the oxygen level with the use of liquid nitrogen. Shortly after a few minutes, people pass on to the afterlife to meet their maker.

When the person lies in the capsule, he can activate it and liquid nitrogen will rapidly drop the oxygen level, leading to death in a few minutes.

“Design criteria for the Sarco will be free, made open-source, and placed on the internet,” reports LN.

Nitschke believes that the Sarco capsule will usher in a new era of rational people ending their lives in peaceful ways without the use of doctors or drugs.

“Sarco does not use any restricted drugs, or require any special expertise such as the insertion of an intravenous needle,” says Nitschke. “Anyone who can pass the entry test, can enter the machine and legally end their life.”

No “restricted drugs” or needles? So long as it involves no animal testing or contributes to climate change, progressives will love the Sarco capsule.

Complete Article ↪HERE↩!

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Four Tasks Between Death and Burial

After death, there are four main tasks that need to happen before the burial. These can be achieved with the help of a funeral home or with the help of loved ones facilitating a home funeral. Learn what needs to take place between death and burial and the role of a funeral home versus a home funeral during the process.

When preparing for death, many people know that there are options for how a person is treated as they are dying. Documents may be completed, hopefully well in advance of the dying process, to express those personal wishes. Documents may include a Living Will, Health Care Power of Attorney, or 5-Wishes. Few know that there are options for after-death care. There are 3 options for the disposition of the body between death and interment or cremation:

Option 1: Hire a funeral home to carry out all aspects of after-death care, including transportation, refrigeration, initiation of death certificate, obituary, cremation and/or transportation to place of burial, and coordination of set up at cemetery for the graveside service.

Option 2: Hire a funeral home to carry out some of the above mentioned aspects of after-death care and take care of other details utilizing family and friends.

Option 3: Have family and friends direct the details of after-death care. This process is call a Home Funeral.

Four Main Tasks

Regardless of which option you choose for after-death care, four main tasks will need to take place between death and burial:

  1. Transportation From Place of Death: The body may need to be moved from the place of death (such as a hospital/nursing facility or home) to the place of after death care (either a home or a funeral home).
  2. Care of the Body: The body will need to be cared for until the time of burial. This care may include bathing, dressing, refrigeration or dry ice application, and perhaps wrapping in a shroud before cremation or burial.
  3. File Death Certificate: A death certificate will need to be filed. This includes gathering the information to complete the certificate, signature from attending physician, and filing with the county registrar.
  4. Transportation To Burial Site: The body will need to be transported from the place of care to Carolina Memorial Sanctuary when it’s time for the burial.

Between Death & Burial: Four Tasks

Before we go over the four steps that take place between death and burial, it’s important to understand the difference between a funeral home and a home funeral. If you’re not clear on the differences, read this page first.

The four tasks between death and burial are pretty detailed, so we’ve created the following graphic to help show your options. Scroll down to see a written explanation of the four main tasks.

Task 1: Transportation From Place of Death

Death can occur anywhere but will often occur at home, in a hospital, or in a hospice center. For unexpected deaths, the body is often brought to a hospital to be examined by the medical examiner. Depending on whether you’re opting for a home funeral or the assistance of a funeral home, the body will need to be transported to the place of care.

Funeral Home

If you hire the assistance of a funeral home, they will come to the place of death and pick up the body and take it to the funeral home for care.

Home Funeral

If you are having a home funeral, you can pick up the body from a hospital, hospice center or morgue and bring it home yourself. You also have the option of hiring a funeral home to pick up the body and transport it to the home for you. If you choose to pick up the body yourself, CEOLT is happy to act as a liaison to help that transition go smoothly.

Task 2: Care of the Body

Until the time of burial, the body will need to be cared for and kept cool. Again, this can be done at home or at a funeral home.

Funeral Home

Once a funeral home has picked up the body and brought it to their facility, they will then clean and dress and/or shroud the body. Afterward, the body will be placed in refrigeration to keep it cool until the day of burial, at which point the body will be transported to the burial site.

Home Funeral

For home funerals, once the body has been transported to the house, the body is first cleaned and then dressed and/or shrouded, and then placed in a room where the body can rest and where friends and family can visit if they choose. To keep the body cool, dry ice is usually employed. Certain traditions and spiritual faiths observe the practice of allowing the body to lie in state for multiple days. Using proper care, a body can be kept in the home for multiple days without issue until the time of burial. There are exceptions to this and having the support of an experienced person from CEOLT or going through the home funeral course will help to address the circumstances that could arise. Caroline Yongue, our Director, has been assisting families with home funerals for over 20 years, and has rarely encountered a situation where a home funeral wasn’t possible.

Task 3: File Death Certificate

While the body is being cared for and waiting for burial, a death certificate will need to be filed.

Funeral Home

If going the route of a funeral home, they will file the death certificate for you. You will need to provide personal information of the deceased.

Home Funeral

If doing a home funeral, an individual who is assisting will need to file the death certificate.  This includes gathering the personal information for the deceased, obtaining the signature and cause of death from the attending physician and filing the death certificate with the County Registrar (in the county where death happened).

Task 4: Transportation To Burial Site

The final task to carry out will be to transport the body to the burial site just prior to the time of burial. The date of burial will need to be coordinated with Carolina Memorial Sanctuary in advance so that we can prepare the grave and prepare for the service.

Funeral Home

On the date of the burial, the funeral home will transport the body to Carolina Memorial Sanctuary usually 30-60 minutes before the service is scheduled to begin. They will either release the body to Carolina Memorial Sanctuary or transport the body to the gravesite, depending on the circumstances.

Home Funeral

Just like with the first transportation, from the place of death to the place of care, getting the body from the home to the Carolina Memorial Sanctuary can be done by friends/family assisting with the home funeral or a funeral home can be hired for this service. Carolina Memorial Sanctuary will consult with you and recruit the help of volunteers if additional hands are needed to transport the body from the vehicle to the gravesite.

Final Thoughts: Saying Goodbye Before the Body Is Taken Away

We want to end by sharing some final thoughts on saying goodbye to your loved ones. Contrary to popular belief, the body does not have to be whisked away the moment death occurs. When death occurs at home, most people believe that they are obligated to immediately call 911 or a funeral home so they can quickly transport the body away. Or if a loved one has died at a hospital or hospice center, there may even be pressure from the staff to have the body removed. If you have decided to use a funeral home and the body will not be coming back home, you have the right to ask to spend time with the body of your loved one and say goodbye before the body is transported away from your home/the hospital/hospice center. The opportunity and time to say goodbye can be very healing and beneficial and help with closure and grieving. If a loved one dies at home, you can let the funeral home know that you would like some time with your loved one before they come to pick them up. It doesn’t even have to be the same day (this is known as a “delayed pickup”). If a loved one dies at a hospital or hospice center, let the staff know that you would like time with your loved one. They will often allow a number of hours for this to  take place. You even have the option of having the funeral home bring the body to the home for goodbyes, and then have them transport the body to the funeral home for care and refrigeration before burial. Last – you always have the option of going to the funeral home and having your goodbyes there. The time after death is the last time some people have to see their loved ones and say goodbye – so be sure to ask for what you want and what you need and know that you can take your time.

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Can a dying patient be a healthy person?

By and

[T]he news was bad. Mimi, a woman in her early 80s, had been undergoing treatment for lymphoma. Her husband was being treated for bladder cancer. Recently, she developed chest pain, and a biopsy showed that she had developed a secondary tumor of the pleura, the space around one of her lungs. Her oncology team’s mission was to share this bad news.

Mimi’s case was far from unique. Each year in the U.S., over 1.6 million patients receive hospice care, a number that has been increasing rapidly over the past few years. What made Mimi’s case remarkable was not the grimness of her prognosis but her reaction to it.

When the members of the team walked into Mimi’s hospital room, she was lying in bed holding hands with her husband, who was perched beside her on his motorized wheelchair. The attending oncologist gulped, took a deep breath, and began to break the news as gently as he could. Expecting to meet a flood of tears, he finished by expressing how sorry he was.

To the team’s surprise, however, no tears flowed. Instead Mimi looked over at her husband with a broad smile and said, “Do you know what day this is?” Somewhat perplexed, the oncologist had to admit that he did not. “Today is very is special,” said Mimi, “because it was 60 years ago this very day that my Jim and I were married.”

The team members reacted to Mimi with astonishment. How could an elderly woman with an ailing husband who had just been told that she had a second, lethal cancer respond with a smile? Compounding the team’s amazement, she then went on to share how grateful she felt for the life she and her husband had shared.

Mimi thanked the attending oncologist and the members of the team for their care, remarking how difficult it must be to deliver bad news to very sick patients. Instead of feeling sorry for herself, Mimi was expressing sympathy for the people caring for her, exhibiting a remarkable generosity of spirit in the face of a grim disease.

The members of the team walked out of Mimi’s room shaking their heads in amazement. Once they reached the hallway, the attending physician turned and addressed the group: “Mimi isn’t the only person in that room with cancer, but she is surely the sickest. And yet,” he continued, to nods all around, “she is also the healthiest of any of us.”

“Be thine own palace, or the world’s thy jail.” – John Donne

Disease need not define us

Mimi’s reaction highlights a distinction between disease and illness, the importance of which is becoming increasingly apparent. Simply put, a body has a disease, but only a person can have an illness. Different people can respond very differently to the same diagnosis, and those differences sometimes correspond to demographic categories, such as male or female. Mimi is a beautiful example of the ability to respond with joy and gratitude in the face of even life’s seemingly darkest moments.

Consider another very different patient the cancer team met with shortly after Mimi. Ron, a man in his 40s who had been cured of lymphoma, arrived in the oncology clinic expecting the attending oncologist to sign a form stating that he could not work and therefore qualified for disability payments. So far as the attending knew, there was no reason Ron couldn’t hold a job.

Ron’s experience of disease was very different from Mimi’s, a phenomenon familiar to cancer physicians. Despite a dire prognosis, Mimi was full of gratitude. Ron, by contrast, though cured of his disease and apparently completely healthy, looked at his life with resentment, even anger. He felt deeply wronged by his bout with cancer and operated with a sense that others should do what they could to help make it up to him.

Mimi was dying but content with her life. Ron was healthy but filled with bitterness. Both patients had the same diagnosis – cancer – but the two human beings differed dramatically, and so too did their illness experiences. Mimi felt blessed by 60 years of a good marriage, while Ron saw in his cancer just one more example of how unfair life had been to him.

“Death be not proud, though some have called thee Mighty and dreadful, for thou art not so…” – John Donne

The real meaning of health

When the members of the cancer team agreed that Mimi was the healthiest person in the room, they were thinking of health in terms of wholeness or integrity. In fact, the word health shares the same source as the word whole, implying completeness or fullness. Ron felt repeatedly slighted, but Mimi looked at life from a perspective of abundance.

A full life is not necessarily marked by material wealth, power over others, or fame. Many people who live richly do so modestly and quietly, never amassing fortunes, commanding legions, or seeing their picture in the newspaper. What enriches their lives is not success in the conventional sense but the knowledge that they have done their best to remain focused on what really matters.

Mimi easily called to mind many moments when she and those she cared about shared their company and their love. Any sense of regret or sorrow over what might have been quickly gave way to a sense of gratitude for what really was, still is, and will be. Her outlook on life was shaped by a deep conviction that it had a meaning that would transcend her own death.

When someone has built up a life ledger full of meaningful experiences, the prospect of serious illness and death often do not seem so threatening. For Mimi, who had lived most of her days with a keen awareness that they would not go on forever, death’s meaning had been transformed from “Life is pointless” to “Make every day count.”

Mimi regarded the prospect of dying as a lens through which to view the meaning of life. She saw her illness as another adventure through which she and Jim would pass. Death would separate them, but it would also draw them closer together, enabling them to see more clearly than ever how much their love meant to them.

From Mimi’s point of view, death is not a contaminant, fatally introduced to life at its final stage. Instead death is a fire that burns away all that is not essential, purifying a person’s vision of what is most real and most worth caring about. Though not happy to be ill, Mimi was in a profound sense grateful for death. Her sentiments echo those of the poet John Donne:

“One short sleep past and we wake eternally: And death shall be no more; death, thou shalt die.”

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Two state medical societies drop opposition to medical aid-in-dying

by Joanne Finnegan

[T]wo state medical societies have dropped their opposition to medical aid-in-dying, a position that mirrors growing acceptance of the practice among many doctors.

The Massachusetts Medical Society on Saturday became the 10th chapter of the American Medical Association to depart from the profession’s long-standing opposition to physician-assisted dying, according to an organization announcement.  

The Vermont Medical Society also recently joined the list of medical associations that have voted to take a neutral stance on physician-assisted death. Massachusetts and Vermont joined medical societies in California, Colorado, Maryland, Maine, Minnesota, Nevada, Oregon and the District of Columbia in dropping opposition to what was once called physician-assisted suicide. Supporters of legislation that allows doctors to write a prescription for a lethal dose of medication that terminally ill adults can use to end their lives now prefer the term medical aid-in-dying.

The shift in position is a new one, as nine of those medical societies adopted a neutral stance in the last two years, according to the group Compassion & Choices. The group praised the action by the Massachusetts physicians’ group, which it hopes will improve the chances for passing legislation in the Bay State to legalize aid-in-dying.

The society’s House of Delegates voted to adopt a position of “neutral engagement,” which it says will allow it to serve as a medical and scientific resource as part of legislative efforts that will support shared decision-making between terminally ill patients and their physicians. The change followed the release of a survey of the society’s members that showed they supported the aid-in-dying bill the state legislature is considering by a 2-1 margin, Compassion & Choices said.

Also applauding the decision was Roger Kligler, M.D., a retired doctor who has stage 4 metastatic prostate cancer and filed a lawsuit against the state seeking the right to die using self-administered medication. Compassion & Choices and a fellow physician, who wants the right to prescribe medications to help patients die without fear of prosecution, have joined in that lawsuit.

“I am excited about this decision because the legislature greatly respects the medical society’s positions on healthcare issues and its previous opposition to medical aid-in-dying was a serious roadblock to passing legislation authorizing this end-of-life care option. I’m extremely grateful for the society’s change of heart,” Kligler said in the group’s announcement.

The Massachusetts society’s vote came after considerable discussion, as aid-in-dying raises ethical questions for many physicians.

Six states, including California, Colorado, Montana, Oregon, Vermont and Washington, as well as the District of Columbia, have explicitly authorized medical aid-in-dying

In Vermont, the medical society’s action caught up with existing law. The society dropped its opposition to the state’s 2013 death with dignity law, adopting a resolution at its annual meeting that says doctors have a right to decide if they should assist their patients in ending their lives.

While some physician groups have changed their stance, others have held firm. The American College of Physicians published an updated position statement in September reaffirming its opposition to legalization of what it still calls physician-assisted suicide.

Complete Article ↪HERE↩!

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You CAN Take It with You When You Go

By Alison Morris

Let’s say you’re mortal. Now let’s say you’re a book lover. Where’s the intersection between these two things? You guessed it — bookcase coffins. Which (with apologies to you squeamish types) is the theme of today’s post.

In my travels around the web searching for apartment storage solutions, I stumbled upon (and — really — it felt like I’d actually stumbled when I came across these) two different bookcases that double as coffins. This way you can hide your coffin in plain sight if you want to own and take possession of a coffin before you die, which apparently an increasing number of people are choosing to do.

Let me pause for a brief confession here: when I first found these bookcase coffin images, I thought this was going to be a funny post — a “what an odd and offbeat idea, let’s all laugh about it” post. BUT then I read the content of the webpages on which these coffins appeared, and the topic suddenly became both a lot less humorous AND a lot more interesting.

The first two bookcase coffins below come from the website of a Maine group called Last Things: Alternatives at the End of Life. The group and website were created by  Klara Tammany, whose moving essay about her own mother’s burial illustrates the reasons her family and others are choosing to have green burials and rejecting what she sees as impersonal and ecologically damaging funeral and burial practices. Last Things offers support and resources for those looking for more information about alternative burial options. The coffins displayed on their site (including this one) are all handmade by group member/woodworker Chuck Lakin. The first one here is the Bookcase Coffin model.

This second model is what Chuck calls a Multipurpose Coffin. It can be used either as a bookcase OR as an entertainment center, and I personally think it’s 100% convincing as either of those things. (I mean, really — who would know?)

Like Chuck Lakin, New Zealand company Final Furniture Limited is creating coffins mindful of eco-conscious clients. Their nextgen bookshelf/wine rack allows you to raise a glass to your past while, well, facing your future. The photo on the beach at the top of this post shows how the bookcase/winerack looks in its… alternate form. (I feel like I’m writing about a Transformer here.)

While the Last Things and Final Furniture bookcase coffins are probably intended more for people nearing the end of their lives, this next one (via Inhabit), which designer William Warren calls Shelves for Life, is not. As Warren explains, “Shelves For Life is a self-initiated project to further explore ideas of built-in sentimentality within our possessions. The aim is to make stronger emotional relationships with our belongings and encourage lifelong use… They are intended to be used throughout life as storage for personal belongings. On death, the shelves are dismantled and rebuilt as a coffin.”

Maybe I’m being swayed by the fact that we’re about to spend some money on a “real” sofa which feels like an almost-lifelong commitment, but I like the rather anti-IKEA aim of Warren’s experiment with this. (Note, though, that someone has apparently come up with plans to make an IKEA bookcase coffin too.) Disposable is bad. You can store things in it now AND be buried in it later is, um… Good. Mostly. Especially when the design is as elegant as this.

That having been said (and this is the problem), I’m not sure how it would feel to be shelving books in and dusting knick-knacks on my future coffin. Suddenly that bookcase would feel a bit TOO important to me, I think. (God forbid the movers drop THAT one!) And I’m not sure I’d want such a large, visual reminder of my own mortality in my living room. Unless its presence would encourage me to procrastinate less and work more… Hmmm.

In looking around for more info on this topic I came across a thoughtful post on a blog called Pink Slip by one Maureen Rogers, that concludes thusly: “I have just gauged that our old Workbench bookcases are neither deep enough nor sturdy enough to act as coffins. If, when the time comes when Jim and I experience the miracle of death, we’re planning on anything other than cremation and scatter, I would consider one of [Chuck Lakin’s] creations. I’d probably go for the coffee table version. We can always use more storage.”

And, Maureen, you’d always have it too.

Complete Article ↪HERE↩!