Tag: Conscious Dying

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Planning for end-of-life expenses amid soaring costs

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In the realm of financial planning, agents and advisors diligently guide their clients through the complexities of retirement savings, investments, and insurance. Yet, there’s a critical aspect that often doesn’t receive the attention it warrants until it’s too late: the cost of dying. Recent data reveals a stark reality: The price tag attached to end-of-life care and funeral expenses is climbing, propelled by inflation and escalating health care costs. Let’s look at the implications of these rising costs and outline strategies financial professionals can employ to assist their clients in preparing for the future.

The unavoidable cost of dying

The Consumer Price Index indicates a notable 4.8% increase in funeral costs over the past year, signifying the upward trajectory of end-of-life expenses. An average American now faces more than $24,000 in medical and funeral costs at life’s end. Specifically, end-of-life medical expenses average more than $16,000, while the median funeral cost nears $8,000. These figures highlight an uncomfortable truth: even in death, one cannot escape the financial implications of inflation.

Deepening funeral costs

The average funeral in the U.S. costs between $7,000 and $12,000, encompassing expenses from caskets and embalming to transportation, plots, flowers, services, headstones and funeral home fees. Opting for more elaborate services or higher-end options can significantly inflate these costs. This financial burden is not one most individuals wish to impose on their relatives posthumously.

The true ‘killer:’ Medical care costs

Although funeral expenses are steep, the cost of medical care in the final stages of life is even more daunting. Medicare provides some relief but hospital, palliative care and hospice care costs continue to surge. Hospital stays can exceed $10,000 per day before insurance. Despite a preference for dying at home, only about 25% of individuals do so, with the majority ending their lives in some form of medical care facility.

Planning for estate and legal considerations

Beyond medical and funeral costs, there are estate and legal fees to consider. The process of settling an estate and distributing inheritances involves a complex web of legalities, adding another layer of expense that can easily propel total end-of-life costs beyond $50,000.\

Strategic planning for end-of-life expenses

  • Savings and investments. One approach is for clients to allocate a portion of their savings or investments specifically for end-of-life expenses. This proactive measure can mitigate the financial impact on loved ones.
    • Insurance solutions. Life insurance or specialized end-of-life insurance products can offer a safety net for funeral and other final expenses. However, seniors may face high premiums, and those with existing life insurance policies may be overinsured if they plan to use these funds solely for funeral costs.
    • Life insurance settlements. For seniors facing steep life insurance premiums or those with more insurance coverage than necessary, a life insurance settlement presents a viable option. Selling their policy in the secondary market can provide them with a lump sum to cover end-of-life expenses, freeing them from the burden of escalating premiums.

    The role of agents and advisors

    Financial professionals play a pivotal role in navigating these complex waters. By conducting policy appraisals, advisors can determine whether a life insurance settlement is appropriate, potentially reallocating those funds toward long-term care insurance or directly covering end-of-life expenses. This strategic planning can alleviate the financial strain on clients and their families, ensuring a more manageable and dignified end-of-life experience.

    As the costs associated with end-of-life care continue to rise, agents and advisors are tasked with a crucial responsibility: to help their clients plan comprehensively, considering not only the joys of retirement but also the inevitable costs of dying. By exploring all available options, from savings and investments to insurance products and life insurance settlements, financial professionals can guide their clients toward peace of mind for themselves and their loved ones. Inflation may be an unyielding force, but with thoughtful planning and strategic advice, navigating the financial aspects of end-of-life can be less burdensome, allowing individuals to focus on living their final days with dignity and grace.

    Complete Article ↪HERE↩!

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Human Composting

— A Green Way to Return to the Earth

Human composting turns death into an opportunity to help the planet heal.

A natural burial is good for the planet and lets you be reborn as a part of nature

By HONORAH BROZIO

When someone dies, they can be put in the ground or an urn — but many are unaware that there is an alternative that returns the body to the earth in a natural way. Instead of traditional burial or cremation, there is human composting, which honors the natural cycle of life and creates a memorial specific to our loved ones without harming the earth.

Human composting is a simple process that lays the body on a bed of wood chips, alfalfa and straw. The body decomposes and turns into fresh usable soil in five to seven weeks. According to the human composting facility, Recompose, one human turns into about one truck bed of soil which can be used for a garden, tree or even spread among a forest.

Why is human composting better than traditional embalming or cremation practices? It is important to consider the average postmortem process. One day a man named Body dies. Body hangs out with the mortician who pumps him full of embalming fluids, drains his blood, removes his organs and creates a chemically preserved thing that is not natural, not human and definitely not Body.

When I think about modern death practices I wonder, why do we ignore death when we can embrace it?

The work involved in the embalming process is not natural for a human to experience and it exposes the mortician to harmful chemicals. The National Funeral Directors Association claims that embalmers inhale high levels of formaldehyde and are at risk for coughing, nausea, facial irritation and, in some cases, leukemia.

After the preparation, Body’s family picks out a casket, plans a ceremony, buys enough flowers to start a flower shop and buys a plot of land. So, is it worth it? Is it worth it to expose morticians to harmful chemicals and waste resources for a process that attempts to slow decomposition and maintain a body that is no longer alive?

Modern funeral practices involve cement vaults and caskets in order to preserve our loved ones for as long as possible. We delay the decomposition process for about a decade so that our bodies resemble canned goods in the bottom of a cement bunker. We waste time, thousands of dollars and land all because we want to look at our loved ones and imagine they’re still alive. When I think about modern death practices I wonder, why do we ignore death when we can embrace it?

Human composting is the opposite of traditional burial. With human composting, our bodies replenish the earth, not take from it. The process allows us to be among the trees or a meadow where we will forever contribute to the circle of life.

The possibilities of soil are endless. When I die, I want to become a carrot patch. With human composting, you could be a lemon tree or a tulip garden, and your family could make a garden and sit under the shade of your tree.

You are not a preserved lump at the bottom of a cement vault or a pile of ashes on the mantel. Rather, you would nourish the roots of your favorite plant and your family would be with you, laying under the sun.

Each individual is capable of changing the way we see death. After all, America’s extravagant funeral practices and embalming methods are relatively modern. The Library of Congress associates America’s booming death care industry with the Civil War because families wanted their loved ones preserved and returned from war. Embalming remained popular after the success of President Abraham Lincoln’s embalmed body during his lavish funeral tour. If luxurious funerals and embalming were influenced by societal changes, I believe human composting can reach the same degree of acceptance someday.

Moreover, human composting is crucial to the future of our planet. In 2019, the Population Reference Bureau notes that roughly 3 million Americans died. Typically, more than half of the population chooses cremation and the rest choose traditional burial meaning millions of people harm the earth for funerals on an annual basis.

If luxurious funerals and embalming were influenced by societal changes, I believe human composting can reach the same degree of acceptance someday.

Recompose claimed on their website that: “Cremation burns fossil fuels and emits carbon dioxide … Conventional burial consumes valuable urban land, pollutes the soil, and contributes to climate change through resource-intensive manufacture and transport of caskets, headstones, and grave liners.”

Earth Funeral, a human composting company in New York, shared similar data claiming one cremation produces about 535 pounds of CO2. While cremation saves land resources, it usually involves burning embalmed bodies which releases toxic chemicals into the air.

Unfortunately, human composting is only legal in seven states including Washington state, Colorado, Oregon, Vermont, California, Nevada and New York. Even then, there are only a handful of human composting facilities in the country. Earth Funeral is accessible for people in New York, but if someone from Texas wanted to be composted they would have to transport the body all the way to a different state with a facility. 

The U.S. needs to legalize human composting in all 50 states because everyone should have the option to decay. I find it ridiculous that America’s legal burial options harm the earth but natural decomposition is illegal in 43 states. We’re allowed to be preserved and burned but not returned to the earth. We’re allowed to kill the planet but not help it.

Everyone can help promote human composting. It’s easy to spread awareness by sharing websites such as Recompose or Earth Funeral with your friends and family. Additionally, you can follow Recompose’s legislative tracker, a resource that updates visitors on which states are in the process of legalizing human composting.

By destigmatizing environmentally friendly burial options, we can move away from harmful burial choices and make decomposition a common burial practice. Normalizing human composting starts with the small steps of educating our peers until the knowledge reaches the legislature. Instead of scarring the earth, we can return to it.

Complete Article ↪HERE↩!

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Speaking of death

— Christians have an opportunity to eschew euphemisms and talk honestly about mortality.

By Rachel Mann

When my father died a couple of years ago, my family asked me to take the lead in organizing his funeral. I was happy to take this role: I am an experienced cleric used to working with funeral directors, and I have a strong understanding of the funeral process. What I’d never previously experienced—at least not from the point of view of a grieving person—is how readily those involved in the ministrations around a death speak in euphemisms. Perhaps it was a token of my grief, but I was annoyed by how many people couldn’t even say that my dad had died; most people, including the funeral director, said, repeatedly, that he’d “passed.”

Does it matter? At one level, no. The phrase “passed away” has been used to refer to death for 500 years. Still, it troubles me theologically. I fear that the prevalence of using passed as a way of speaking (or not speaking) of death indicates a society frightened by the finality of death, one that has opted for an overly spiritualized response to the last enemy.

A common refrain in my clergy circles is about how, on visits to plan funeral services with the bereaved, the only person prepared to use the “D” word is the priest herself. The bereaved will typically resort to any number of euphemisms to avoid it. This is entirely understandable. Shock is a natural reaction to death and, as creatures of language, we may be inclined to retreat to clichés that seem to soften the blow.

Indeed, at one level, euphemisms are entirely comprehensible as strategies to avoid the things we struggle with most. As Voltaire noted, “One great use of words is to hide our thoughts.” This applies to any difficult aspect of life, not simply death. Terms like downsizing and rationalization have been used for decades in business settings to avoid speaking directly about job cuts. In almost every area of life that really matters or troubles us—from sex through to war—there are forms of words that have been found to smooth out what’s difficult.

If death is the greatest human fear, it is hardly surprising that most of us will find ways of avoiding talking about it. The sheer number of ways humans have of avoiding the “D” word is both a testament to our creativity and an indication of how much we fear death.

Yet I think one of the imperatives on us as Christians is to be as honest as we can about death. Priests in particular are called to help people to pray and prepare them for death. Ironically, in an age when Christians are often parodied as delusional fantasists, we in fact have something powerful to offer as people who model realism and honesty about death. And one way we do that is by avoiding euphemisms at the point of death. If euphemisms are deployed in part to soften the nature of something shocking and appalling, ironically they serve to draw greater attention to that which they are meant to conceal. By being carefully and humanely honest about the singular finality of death, both priests and laypeople may be key agents in helping the bereaved to come to terms with the simple fact that, in this life at least, their loved ones are gone.

I am not suggesting that Christians should be crass. I trust we will always be sensitive to death’s ability to strip any of us of our certainties. But the quiet acknowledgment of the final nature of death may be significant both pastorally and for mission. In being clear that death has a shocking finality about it, Christians—as people who are committed to resurrection and new life—may be better placed to speak the good news of Christ. One thing we should not be afraid of in our faith tradition is the bleak reality that God incarnate, Jesus Christ, actually died and died horribly. He did not fall asleep or pass over or, to quote George Eliot, “join the choir invisible.” He died, in a vile and appalling way.

Resurrection is predicated on death. This is a powerful message in an age and culture in which technology and market economics have created the illusion that life and growth are almost endless. Growth is taken to be always good—and to be fair, growth is often a sign of life. Yet Jesus invites us to remember that unless a kernel of wheat falls and dies it remains a single seed. Jesus himself models a way of living abundantly that is grounded in the unavoidable reality of death.

Increasingly I read stories of billionaires seeking to cheat death altogether. In a culture where medical technologies have extended life among the wealthy to unprecedented levels, Christianity retains a potent voice on the inescapability of death. Even more powerfully, the figure at the heart of the Christian faith, Jesus Christ, signals that a fulfilled and rich life is not by its nature dependent on its length. At a time when religious faith is often parodied as absurd, childish, and fantastical, there is a profound opportunity to speak to the privilege of individuals and societies that seek to isolate themselves from the facts of human existence.

I know that there is nothing much I can do, as an individual, about the use of passing as a euphemism for death. At the same time, I can think of no greater vocation as a person of faith than to speak honestly about death, trusting in that even deeper reality of God’s resurrection.

Complete Article ↪HERE↩!

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A cancer patient had decided how to die.

— Here’s what I learned from her.

For those with a terminal diagnosis, it’s getting easier to control death, but the process remains complex

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I first learned about “medical aid in dying” last spring when my sister, Julie, who suffered from advanced ovarian cancer, chose to end her life — in accordance with New Jersey law — after all realistic treatments had been exhausted and the pain medicines prescribed could no longer alleviate her suffering. At that time I didn’t know anyone else who had taken this step. While Julie’s hospice social worker provided answers to our questions, there was much I didn’t know about medical aid in dying at the time she died at age 61, much that I wish I’d understood better.

After Julie’s death, Lynda Shannon Bluestein, 76, became one of my teachers. The married mother of two also suffered from late-stage ovarian — and fallopian — cancer.

In a series of conversations last fall Bluestein told me she had wanted to plan for medical aid in dying when her condition worsened, but medical aid in dying, or MAID, is not legal in her home state of Connecticut. However, it was legal in nearby Vermont, but barred to nonresidents. Last year Bluestein sued the state to eliminate the residency requirement, which put her on front pages throughout New England.

Last March, when her chemotherapy regimen become too much to bear, she stopped treatment and began hospice care. By May she’d won her court case and the right to utilize Vermont’s medical aid in dying procedures

Like others who want to use life-ending medications, Bluestein had to follow a carefully prescribed process, which begins with a terminal diagnosis. Following Vermont’s MAID law, known as Act 39, Bluestein made two verbal requests to her attending doctor, at least 15 days apart, then made a written request signed by two witnesses who were 18 or older.

As she told me, “My two witnesses had no interest in my estate and no influence on my life [and] they weren’t related to me in any way.” (This ended up later sparking a journalism controversy when it turned out one of the witnesses was a columnist from the Boston Globe, who had been writing about Bluestein.) As a final step, a second physician reconfirmed that she met all the qualifying criteria.

By October, when we first spoke, Bluestein had met all the requirements. And so Diana Barnard, a Vermont family medicine doctor who is board certified in hospice and palliative care, called in the prescription for the mix of sedatives and barbiturates to the one pharmacy in the state that dispenses them. They would be held there until Bluestein needed them and would cost her $700 out of pocket, since Medicare, her insurance provider, does not provide coverage.

I spoke with Barnard about what happens during the procedure. “It’s harder to hasten a death than you might imagine,” she said. Five powerful medications are currently used, including diazepam, digoxin, morphine sulfate, amitriptyline, and phenobarbital. Death usually comes within 90 to 120 minutes but can take longer, she explained.

Bluestein completely understood what would happen after she swallowed the lethal mix of medicines. When we last spoke by phone, she told me she worried that if she waited too long, she’d be unable to ingest the drugs or would throw them up. When it became clear over the year end holidays that her health was deteriorating rapidly, she chose her date.

On Jan. 3, she and husband, Paul, drove to a private hospice facility that provides “a safe and caring space” for patients to end their lives.

Barnard explained that when a patient is ready to take the meds, they, a relative or friend would mix the drugs with water or apple juice. It’s crucial to imbibe the entire potion within two minutes for the greatest efficacy, said Barnard. Within a couple of minutes, patients lose consciousness, she said, and “appear to be unaware and not experiencing external stimuli,” with just the heart and lungs still working. Then comes the waiting for the end.

The 2022 Oregon Death With Dignity annual summary reported rare complications such as difficulty swallowing and regurgitation, but Barnard said there are precautions that can prevent most of them. (Oregon is one of 10 states plus the District of Columbia that now allow MAID.)

For instance, Barnard makes sure her patients can swallow effectively and can drink the whole mixture at once (some people practice with a placebo or view a video enactment of how to take these drugs at bedside).

On the morning of Jan. 4, now in Vermont, Bluestein and her husband Paul got up early, he said, and after the rest of the family arrived, he gave her the premedication (which makes the patient calm and drowsy, though not too drowsy to take the next step). After 30 minutes, the hospice owner came in to mix up the life-ending cocktail. He asked her if she was ready, and according to Paul she replied, “I’m so happy I don’t have to suffer anymore.” She drank it all — quickly.

Bluestein was unconscious within five minutes, her husband said. “She looked like she had fallen asleep peacefully. … A lot of the pain that was in her face went away, and I was grateful.” She was pronounced dead by a hospice nurse after just 25 minutes.

A few weeks after Bluestein’s death, I asked Paul Bluestein about the pain she had endured. He replied in a text: “There are some things in life no one should have to see and one of them is watching someone you love in pain.” It was “intolerable” and “undescribable.”

During my last phone call with Bluestein, she made a point to say that making her plan “was extraordinarily difficult. You really have to want to do this a lot, have a fair amount of money, a lot of flexibility, and be very well connected to accomplish this.”

I understood exactly what she meant, as the same had been true for my sister, who, while suffering, had to arrange this last medical procedure.

For critics who fear that MAID could make it too easy for someone to take their own life, or to pressure someone else to take theirs, I offer Bluestein’s words, along with my sister’s experience.

It’s not an easy process, and requires deliberation and intent, and the sign-off from others. But it offers an end to much pain and suffering, and that is a gift to those like my sister and Lynda Bluestein.

Complete Article ↪HERE↩!

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Demand for death doulas has soared.

— Here’s how they help patients go with grace.

By Stacey Colino

What does it mean to have the “best possible death?” A growing number of end-of-life doulas are helping patients and families figure that out.

When Jerry Creehan was diagnosed with Amyotrophic Lateral Sclerosis (ALS) in January 2017 at age 64, he and his wife Sue knew they were facing a rough road ahead. For more than a year, Jerry had struggled with his balance and had been falling, unable to get up. ALS (formerly known as Lou Gehrig’s disease) is a progressive neurological disorder affecting nerve cells in the brain and spinal cord that regulate voluntary muscle movement, breathing, and other bodily functions; it eventually leads to paralysis and death.

In 2020, his condition began declining and he became reliant on eye gaze technology to move his wheelchair, and on a non-invasive ventilator to breathe. While attending a support group at the ALS Clinic at Virginia Commonwealth University, Sue heard Shelby Kirillin, an end-of-life doula, speak. Kirillin, a former nurse specializing in neurotrauma, spent two decades working in intensive care units, where she saw “how ill-prepared people are for the end of life. People don’t know how to talk to people with a terminal diagnosis. I thought we could do better.” That’s what inspired her to become an end-of-life doula in 2015.

“We knew we were in the final stages of ALS, and even though Jerry wasn’t afraid of dying, we needed someone to help us talk about it,” recalls Sue, a wound-care nurse consultant in Richmond, Virginia. “He wanted it to be the best possible death it could be, pain-free, and not filled with anguish.”

Many people are familiar with labor doulas, postpartum doulas, and maybe even abortion doulas, who provide support for people dealing with challenges related to ending a pregnancy. By contrast, end-of-life doulas work with those on the verge of dying, and their families. Also called death doulas, these professionals used to be rare but that changed during the COVID-19 pandemic. Since the virus began wreaking havoc, organizations that support and train death doulas in the U.S. have grown. In 2019, the National End-of-Life Doula Alliance (NEDA) had 260 members in the U.S.; membership grew to 1,545 doulas as of January 2024. Research has found that end-of-life doulas are most active in Australia, Canada, the United Kingdom, and the United States.

“During the pandemic, people were facing their own mortality more than at any other time because there was a lot of dying and grief happening,” says Ashley Johnson, president of NEDA, which is based in Orlando.
Offering various forms of support

Generally end-of-life doulas provide non-medical, compassionate support and guidance to dying people and their families. This includes comfort and companionship, as well as social, emotional, spiritual, and practical support (such as household help or running errands), depending on the provider’s strengths and the patient’s needs. Some end-of-life doulas help with estate planning, end-of-life care planning, or legacy planning. Others focus on helping people create an ambiance they want for their last days, facilitate difficult conversations between clients and their loved ones, or help with grief counseling with survivors.

“People don’t want to talk about death—they’re so afraid of it,” says Elizabeth “Like” Lokon, a social gerontologist who recently retired from the Scripps Gerontology Center at Miami University in Ohio and is now training to become a death doula. “As a social gerontologist, I want to bring it out from hiding and help people accept it. In some cultures, the denial of death, the separation between the dying and the living, is not as severe as in some western countries,” adds Lokon, who grew up in Indonesia.

“We labor into life, and we labor out of life,” says Kirillin. “All of us are born with life and death walking next to us.”
Changing the approach to death

Since it was formed in 2015, the International End-of-Life Doula Association (INELDA) has trained more than 5,600 doulas around the world, but the practice and training of death doulas varies considerably. There isn’t a universally agreed upon description of this type of care or federal regulations in the U.S. for becoming an end-of-life doula or oversight of their work. A study in the journal Health & Social Care in the Community concluded that the lack of a business model for death doulas creates inconsistencies in the services death doulas offer and what patients and their families can expect.

For example, INELDA offers a 40-hour training that focuses on the foundations of doula work and support for the dying. By contrast, NEDA is a membership organization that offers micro-credentials after doulas show their knowledge and proficiency in the skills involved. Other training programs offer four-week in-person courses, 12-week online courses, six-week programs, and other formats.

There’s also no standardized fee structure for end-of-life doulas: It typically ranges from $20 to $100 per hour, depending on the location and range of services that are offered, Johnson says. And some death doulas offer a sliding scale of fees or do it voluntarily, on a pro bono basis. Their services are not covered by insurance.

Regardless of how they’re trained or paid, many death doulas find the practice meaningful and fulfilling.

“People find it profoundly moving—some people use the word honor or sacred,” says Douglas Simpson, a trained end-of-life doula and executive director of INELDA. “End-of-life doulas help people take control of what their death looks like … It’s very fulfilling and not as depressing as people think.”
During the pandemic, Julia Whitty, a writer in Sonoma County, California, who had done volunteer hospice work earlier in her life, trained to become an end-of-life doula because her mother and a friend were on the verge of dying. She wanted to be better prepared personally, and she wanted to help other people with a terminal diagnosis in her social sphere.

“It’s a two-way relationship because you’re learning something from someone who’s coming to their end,” says Whitty, “and hopefully you’re helping them manifest what they want in their last days—physically, emotionally, socially, and spiritually.”

Among the things end-of-life doulas don’t do: administer medicine, monitor vital signs, make or recommend medical decisions for the client, impose their values or judgments on clients, or act as therapists.

“We meet people where they are—we come in holistically and help them navigate the final stages of life,” Johnson says. “It’s helping people face their own mortality with dignity. We’re promoting death positivity, decreasing the stigma.”
Creating a peaceful ending

Eleven months before he passed away, Jerry Creehan was put into hospice care and his wife Sue contacted Kirillin who worked with them once or twice each month for an hour at a time then more often as his condition deteriorated.

At first, Kirillin helped them talk about what death looks like and how Jerry could “own” his death. Sometimes she’d spend time just with Jerry, other times just Sue, and sometimes with both of them. As Jerry got weaker, Kirillin helped him come up with rituals to do with loved ones; she talked to Jerry about what he wanted his legacy to be and helped him write letters to loved ones. With Kirillin’s guidance, they created a detailed plan for his funeral and he designated personal belongings to be given to people he loved on his last night. Kirillin suggested they send an e-mail to friends and family members asking them to share memories and photos of time spent with Jerry.

“We got a wonderful response and put together a legacy journal,” recalls Sue who has three adult children and six grandchildren with Jerry. “I would read it to him, and it was very consoling to him to know that he had an impact on people’s lives.”

On his last evening, May 2, 2022, his breathing had become very difficult. There were 19 people in the bedroom, and someone opened a prized bottle of pinot noir to be used for communion with everyone present. Jerry was a certified wine educator, a foodie, an avid golfer, traveler, and a devout Christian, according to his wife of 46 years.

“He turned to me and said, Sweetie, I think it’s time,” she recalls. They kissed and hugged each other—family members helped put his arms around her—and Jerry said to Sue, “I love you. I always have and I always will. I’ll see you soon.” Then he winked at her and closed his eyes, she recalls. His ventilator was turned off and he passed away.

Afterwards, Kirillin and the hospice nurse stayed with him, bathed him, dressed him, and prepared his body for the funeral home.

“We did everything the way he wanted it to be done—that was a big gift to my family,” says Sue.

The Creehans’ experience isn’t unusual. In a study published last year in Palliative Care and Social Practice, researchers interviewed 10 bereaved family members about their experiences with a death doula and found that it was overwhelmingly positive. The most valuable benefit families gained was an increase in death literacy, including the ability to talk openly about death, which helped them feel empowered to care for their loved ones at the end of life. There was also a positive ripple effect as families spread the word about the benefits of using a death doula.

“People don’t want to wait for death to come and get them—they want to play the hand they were given the best they can,” Kirillin says. “We’re all going to die. I can’t change that. But I can help someone end the last chapter of their life the way they think they should. And I will sit next to them as they own it.”

Complete Article ↪HERE↩!

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‘Duo euthanasia’

— In the Netherlands, a famous couple chooses to die together

Former Dutch prime minister Dries van Agt and his wife, Eugenie, in Den Bosch, the Netherlands, in June 1983.

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The vow is “til death do us part.” But for former Dutch prime minister Dries van Agt and his wife, Eugenie, the aim was to leave this life the same way they had spent the past seven decades — together.

The couple, both 93, died “hand in hand” earlier this month, according to a statement from the Rights Forum, a pro-Palestinian organization that Dries van Agt created. They chose to die by what is known as “duo euthanasia” — a growing trend in the Netherlands, where a small number of couples have been granted their wish to die in unison in recent years, usually by a lethal dose of a drug.

A longtime politician who had conservative roots but campaigned for numerous liberal causes, van Agt served as prime minister of the Netherlands from 1977 to 1982. He later became the European Union’s ambassador to Japan and the United States

Photos of the couple from their decades-long careers as public figures often show them walking in step: waving to crowds through a car window, voting together at an election site and giving each other a smooch at a public event.

The van Agts’ health had declined in recent years, Dutch public broadcaster NOS reported. The former prime minister never fully recovered after suffering a brain hemorrhage in 2019, which happened while he was delivering a speech at a commemoration event for Palestinians. Eugenie’s health issues were largely kept private.

“I feel like it’s kind of beautiful, honestly, that you’ve lived your life together, you both happen to be gravely ill without a chance of getting better, you’re ready to go, and you would like to go together,” said Maria Carpiac, director of the gerontology program at California State University at Long Beach.

When it comes to the right to choose one’s own death, the Netherlands is “kind of the model” for any U.S. legislation on the topic, she said.

At least 29 couples — or 58 people — died together via duo euthanasia in 2022, the most recent year of data from the country’s Regional Euthanasia Review Committees. That’s more than double the 13 couples who did so in 2020, when the committee first started looking at partners specifically, but it still represents only a small fraction of the 8,720 people who legally died by euthanasia or assisted suicide in the Netherlands that year.

“It is likely that this will happen more and more often,” said Rob Edens, press officer for NVVE, a Dutch organization focused on research, lobbying and education about assisted suicide and euthanasia in the Netherlands. “We still see a reluctance among doctors to provide euthanasia based on an accumulation of age-related conditions. But it is permitted” in the country’s legal guidelines, he said in an email.

Assisted suicide is when a person self-administers a lethal dose while a physician is present, while euthanasia is when a medical professional administers the dose. Both are legal in the Netherlands when specific criteria are met. (Some groups prefer the term “medical aid in dying,” or MAID, due to religious and social stigma around suicide.)

Euthanasia is illegal in the United States, but assisted suicide is allowed in D.C. and at least 10 states: Oregon, Washington, Montana, Vermont, California, Colorado, Hawaii, New Jersey, Maine and New Mexico. Eligibility requirements tend to be strict across the country, Carpiac said, but there are differences between jurisdictions.

The Netherlands, a country of almost 18 million people, has allowed assisted suicide and euthanasia since 2002. It requires that individuals willingly request the termination of their life in a manner that is “well-considered,” with a sign-off from a doctor that they are experiencing “unbearable suffering with no prospect of improvement.”

Another physician then has to agree that the person qualifies, and doctors can choose whether they are involved in the procedure. After every death, doctors are required to notify a regional review committee, which examines whether each case was handled lawfully. Couples who seek duo euthanasia are required to apply and undergo the review process individually, with separate doctors.

“An accumulation of age-related complaints can lead to unbearable and hopeless suffering,” Edens said, explaining the Dutch guidelines. “The expectation is that if doctors are increasingly willing to provide euthanasia when there is an accumulation of old-age complaints, the number of duo euthanasia [cases] will increase.”

Research suggests that older Americans are at a higher risk of dying after losing a spouse, particularly in the first few months after their death. While the cause of this phenomenon is unclear, studies have found that grieving partners have higher rates of inflammation and are at increased risk of heart attack and stroke, often due to stress-induced changes in blood pressure, heart rate and blood clotting.

“The first thing that came to my mind was the widowhood effect,” Carpiac said, referring to the van Agts’ choice to die by duo euthanasia. “I have a grandmother who is 96, and she’s like, ‘I’m not going anywhere!’ But if I had a partner and they were my person, and we were both kind of at the end of our lives, would it be worth it if he were to go without me? Would I die of what I considered to be a broken heart? I would want to have a choice.”

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A Compassionate Journey

— The Transition from Palliative Care to Hospice

By Mazhar Abbas

The transition from palliative care to hospice is a journey marked not just by the end of life, but by the culmination of a lifetime’s worth of relationships, memories, and the profound need for compassion. In the case of Elaine Arazawa, a 62-year-old woman diagnosed with pancreatic cancer that had metastasized to her liver, the value of community and personalized care in her final days comes into sharp focus. Diagnosed with a condition that led to over a dozen tumors, Elaine’s story underscores not only the medical but also the emotional dimensions of transitioning to hospice care.

Understanding the Transition: From Palliative Care to Hospice

The journey from receiving life-prolonging treatments to focusing solely on quality of life is a critical period for patients with terminal illnesses. This transition necessitates a holistic approach that encompasses open communication and thorough assessment of patient needs. Healthcare professionals play a pivotal role in guiding families through this change, ensuring that care is not only medically appropriate but also aligns with the patient’s and family’s emotional and psychological needs. The story of Elaine Arazawa illustrates the profound impact of a well-coordinated care plan, facilitated by a team of dedicated healthcare providers, death care workers, doulas, nurses, grief counselors, and social workers. Together, they create an environment where patients can find solace and families can navigate the complexities of grief and acceptance.

Key Indicators for Hospice Care

Recognizing the right time to transition to hospice care is crucial for ensuring that patients receive the most appropriate support as they approach the end of their lives. Key indicators include a significant decline in health despite receiving treatment, frequent hospitalizations, and a clear preference from the patient to focus on comfort rather than cure. For Elaine, the decision to enter hospice care came after a candid discussion with her healthcare team and family, highlighting the necessity of open dialogue in making informed choices about end-of-life care. This transition allowed her to spend her final days surrounded by love, reflecting on her life, and engaging in meaningful farewells, emphasizing the importance of timing and communication in hospice care decisions.

Building a Supportive Community

Elaine Arazawa’s experience brings to light the significance of community and emotional support in the hospice care process. Unlike many who faced the end of life alone during the pandemic, Elaine had the fortune of being surrounded by her family and a compassionate care team. This communal approach to end-of-life care not only provided Elaine with comfort and love but also offered her family the emotional support needed to cope with their loss. The involvement of death care workers, doulas, and grief counselors ensured that Elaine’s journey was not only about managing physical symptoms but also about caring for the emotional and spiritual well-being of both the patient and her family.

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