Tag: Conscious Living

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Learning To Advance The Positives Of Aging

By Judith Graham

[W]hat can be done about negative stereotypes that portray older adults as out-of-touch, useless, feeble, incompetent, pitiful and irrelevant?

From late-night TV comedy shows where supposedly clueless older people are the butt of jokes to ads for anti-aging creams equating youth with beauty and wrinkles with decay, harsh and unflattering images shape assumptions about aging. Although people may hope for good health and happiness, in practice they tend to believe that growing older involves deterioration and decline, according to reports from the Reframing Aging Initiative.

Dismal expectations can become self-fulfilling as people start experiencing changes associated with growing older — aching knees or problems with hearing, for instance. If a person has internalized negative stereotypes, his confidence may be eroded, stress responses activated, motivation diminished (“I’m old, and it’s too late to change things”) and a sense of efficacy (“I can do that”) impaired.

Health often suffers as a result, according to studies showing that older adults who hold negative stereotypes tend to walk slowly, experience memory problems and recover less fully from a fall or fracture, among other ramifications. By contrast, seniors whose view of aging is primarily positive live 7.5 years longer.

Can positive images of aging be enhanced and the effects of negative stereotypes reduced? At a recent meeting of the National Academies of Sciences’ Forum on Aging, Disability and Independence, experts embraced this goal and offered several suggestions for how it can be advanced:

Become aware of implicit biases. Implicit biases are automatic, unexamined thoughts that reside below the level of consciousness. An example: the sight of an older person using a cane might trigger associations with “dependency” and “incompetence” — negative biases.

Forum attendee Dr. Charlotte Yeh, chief medical officer for AARP Services Inc., spoke of her experience after being struck by a car and undergoing a lengthy, painful process of rehabilitation. Limping and using a cane, she routinely found strangers treating her as if she were helpless.

“I would come home feeling terrible about myself,” she said. Decorating her cane with ribbons and flowers turned things around. “People were like ‘Oh, my God that’s so cool,’” said Yeh, who noted that the decorations evoked the positivity associated with creativity instead of the negativity associated with disability.

Implicit biases can be difficult to discover, insofar as they coexist with explicit thoughts that seem to contradict them. For example, implicitly, someone may feel “being old is terrible” while explicitly that person may think: “We need to do more, as a society, to value older people.” Yet this kind of conflict may go unrecognized.

To identify implicit bias, pay attention to your automatic responses. If you find yourself flinching at the sight of wrinkles when you look in the bathroom mirror, for instance, acknowledge this reaction and then ask yourself, “Why is this upsetting?”

Use strategies to challenge biases. Patricia Devine, a professor of psychology at the University of Wisconsin-Madison who studies ways to reduce racial prejudice, calls this “tuning in” to habits of mind that usually go unexamined.

Resolving to change these habits isn’t enough, she said, at the NAS forum’s gathering in New York City: “You need strategies.” Her research shows that five strategies are effective:

  • Replace stereotypes. This entails becoming aware of and then altering responses informed by stereotypes. Instead of assuming a senior with a cane needs your help, for instance, you might ask, “Would you like assistance?” — a question that respects an individual’s autonomy.
  • Embrace new images. This involves thinking about people who don’t fit the stereotype you’ve acknowledged. This could be a group of people (older athletes), a famous person (TV producer Norman Lear, now 95, who just sold a show on aging to NBC) or someone you know (a cherished older friend).
  • Individualize it. The more we know about people, the less we’re likely to think of them as a group characterized by stereotypes. Delve into specifics. What unique challenges does an older person face? How does she cope day to day?
  • Switch perspectives. This involves imagining yourself as a member of the group you’ve been stereotyping. What would it be like if strangers patronized you and called you “sweetie” or “dear,” for example?
  • Make contact. Interact with the people you’ve been stereotyping. Go visit and talk with that friend who’s now living in a retirement community.

Devine’s research hasn’t looked specifically at older adults; the examples above come from other sources. But she’s optimistic that the basic lesson she’s learned, “prejudice is a habit that can be broken,” applies nonetheless.

Emphasize the positive. Another strategy — strengthening implicit positive stereotypes — comes from Becca Levy, a professor of epidemiology and psychology at Yale University and a leading researcher in this field.

In a 2016 study, she and several colleagues demonstrated that exposing older adults to subliminal positive messages about aging several times over the course of a month improved their mobility and balance — crucial measures of physical function.

The messages were embedded in word blocks that flashed quickly across a computer screen, including descriptors such as wise, creative, spry and fit. The weekly sessions were about 15 minutes long, proving that even a relatively short exposure to positive images of aging can make a difference.

At the forum, Levy noted that 196 countries across the world have committed to support the World Health Organization’s fledgling campaign to end ageism — discrimination against people simply because they are old. Bolstering positive images of aging and countering the effect of negative stereotypes needs to be a central part of that endeavor, she remarked. It’s also something older adults can do, individually, by choosing to focus on what’s going well in their lives rather than what’s going wrong.

Claim a seat at the table. “Nothing about us without us” is a clarion call of disability activists, who have demanded that their right to participate fully in society be recognized and made possible by adequate accommodations such as ramps that allow people in wheelchairs to enter public buildings.

So far, however, seniors haven’t similarly insisted on inclusion, making it easier to overlook the ways in which they’re marginalized.

At the forum, Kathy Greenlee, vice president of aging and health policy at the Center for Practical Bioethics in Kansas City and formerly assistant secretary for aging in the U.S. Department of Health and Human Services, called for a new wave of advocacy by and for seniors, saying, “We need more older people talking publicly about themselves and their lives.”

“Everybody is battling aging by themselves, reinforcing the notion that how someone ages is that individual’s responsibility” rather than a collective responsibility, she explained.

Underscoring Greenlee’s point, the forum didn’t feature any older adult speakers discussing their experiences with aging and disability.

In a private conversation, however, Fernando Torres-Gil, the forum’s co-chair and professor of social welfare and public policy at UCLA, spoke of those themes.

Torres-Gil contracted polio when he was 6 months old and spent most of his childhood and adolescence at what was then called the Shriners Hospital for Crippled Children in San Francisco. Back then, kids with polio were shunned. “It’s a real tough thing to be excluded,” he remembered.

His advice to older adults whose self-image is threatened by the onset of impairment: “Persevere with optimism. Hang in there. Don’t give up. And never feel sorry for yourself.”

Now age 69, Torres-Gil struggles with post-polio syndrome and has to walk with crutches and leg braces, which he had abandoned in young adulthood and midlife. “I’m getting ready for my motorized scooter,” he said with a smile, then quickly turned serious.

“The thing is to accept whatever is happening to you, not deny it,” he said, speaking about adjusting attitudes about aging. “You can’t keep things as they are: You have to go through a necessary reassessment of what’s possible. The thing is to do it with graciousness, not bitterness, and to learn how to ask for help, acknowledging the reality of interdependence.”

Complete Article ↪HERE↩!

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Don’t want ‘heroic measures’ as part of your end-of-life care? Have the conversation

intubated patient in hospital, intubatation at intensive care unit room respiratory machine with oxygen ventilation monitor

By Allison Bond

[F]or one month this spring, my job as a senior resident in a large teaching hospital entailed racing around the hospital, managing patients who had rapidly become sicker; I wore running shoes every day. I also led every code, orchestrating a team of doctors, nurses, respiratory therapists, and pharmacists in an effort to resuscitate patients after their hearts had stopped. Some of the very sick patients under my care had do-not-resuscitate orders, but most didn’t. For them, my team and I provided whatever treatments we could.

One night, a colleague asked me to see Mr. S, a middle-aged patient with worrisome vital signs.

Arriving at his bedside, my colleague, Dave, and I saw a sluggish, pale man — he’d been in the hospital for almost a month with life-threatening infections. He answered my questions with brief but cogent statements until he suddenly stopped moving, his eyes staring blankly at the wall. I felt for a pulse. There wasn’t one.

“Call a code blue,” I said as calmly as I could, referring to the all-hands-on-deck alert that a patient’s heart had stopped. Dave began doing chest compressions, pressing rhythmically and firmly on Mr. S’s chest, taking the place of the heart in circulating blood throughout his body. I stood at the foot of the bed as the resuscitation team rushed in. A breathing tube wouldn’t pass down Mr. S’s windpipe, so a surgeon performed a cricothyrotomy, cutting a hole in the throat so we could insert a tube to help him breathe. As we paused chest compressions to check for a pulse, 15 wide-eyed faces looked to me to tell them what to do next. Although most in attendance had been involved in attempts to resuscitate patients before, the adrenaline-fueled brutality universal to codes is nearly impossible to get used to. Mr. S’s heart still wasn’t pumping, so we continued.

A few moments later, his arms flailed, thanks to the blood the chest compressions were sending to his brain and the rest of his body. The intern who had taken over for Dave paused in alarm. Another resident reassured her this simply meant her compressions were strong, and urged her to continue pushing.

After more compressions and injections of medicines to bring up the blood pressure and restart the heart, Mr. S’s began to beat faintly. Stable for the moment, we moved him to the intensive care unit. His prognosis was grave, so his family opted against future resuscitations. Later that day, his heart stopped again — that time forever.

We may have revived Mr. S, at least for a few hours, but I’m not sure we really helped him. Were our actions what he truly wanted?

Most people whose hearts suddenly stop don’t survive. Of the more than 200,000 Americans every year who go into cardiac arrest in the hospital, only about one-quarter make it out of the hospital alive. Of those, nearly 30 percent are seriously disabled.

Doctors often don’t adequately convey these grim outcomes; many patients remain falsely optimistic, tending to overestimate their chances of surviving a cardiac arrest. And few people understand what the resuscitation process truly entails, and how these efforts often lead to a painful, undignified death. Recent research also shows that patients and caregivers tend not to be on the same page when it comes to what level of disability or pain might be acceptable to a patient in the future, including after a code.

There’s got to be a way to close these gaps.

The solution starts with a conversation between doctors and their patients about what the end of life might look like. In an effort to make these discussions more common, Medicare now allows doctors to count such discussions, known as advance care planning, as a topic worthy of a doctor’s visit — and of reimbursement under a new billing code — if patients are open to it. Since this change took effect Jan. 1, 2016, nearly 575,000 patients and 23,000 providers have participated in such reimbursed conversations. Of course, there’s plenty of room for improvement: Although that’s almost twice as many conversations as predicted by the American Medical Association, it’s only 1 percent of all people enrolled in Medicare.

It may seem ridiculous to need to pay doctors to have these conversations. Yet given the myriad demands on doctors’ time, making this conversation reimbursable puts it on equal footing with measuring blood pressure, discussing an irregular heartbeat, and other topics long considered vital parts of a doctor visit. These conversations aren’t simply something that are nice to do; they are an incredibly important part of the way patients live and die.

Yet this initiative faces opposition by lawmakers whose fundamental misunderstanding of advance care planning risks seriously harming patients. One such example is the dangerously misnamed Protecting Life Until Natural Death Act, proposed by Rep. Steve King (R-Iowa) this past January. The bill calls for excluding end-of-life discussions from Medicare reimbursement, discouraging doctors from having these important conversations. That’s a problem because in the American medical system, the default position is to do everything possible to revive a patient unless he or she requests otherwise. And in reality, there’s nothing natural about a death prolonged by painful chest compressions, endless needle sticks, and a breathing tube forced down the throat, especially when such efforts are usually futile. In fact, some experts have proposed changing the term “do not resuscitate” to “allow natural death” to better reflect the realities of end-of-life care.

There’s no doubt heroic measures save some lives — but they aren’t what everyone wants. That’s why end-of-life discussions are essential for protecting patients and empowering them to make clear, well-informed decisions that let doctors do right by them. It’s absolutely vital that we keep these conversations going.

Complete Article ↪HERE↩!

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Top Websites Raising Death Awareness

By TalkDeath Team

[I]t’s hard to talk about death without going into the history of it. We’ve talked endlessly on this blog about the ways in which death has changed and evolved over history. We once knew death intimately: we washed the bodies, buried them ourselves and mourned openly and loudly. However today we are, as some scholars would say, largely a death denying culture. The tides are changing and while the chances of us handling the bodies of our loved ones are slim, our awareness of death and dying has been on the rise. Fuelled by popular books, movies, TV shows and personalities, death and death positivity are on the minds of many people. To help foster this much needed change, we present to you the top 8 websites promoting death awareness!

Top Websites Raising Death Awareness

8. Modern Loss

Modern Loss is a place to share the unspeakably taboo, unbelievably hilarious, and unexpectedly beautiful terrain of navigating your life after a death. Beginners welcome. This should say everything you need to know about this wonderful and informative website started by Rebecca Soffer and Gabrielle Birkner. Filled stories of grief, mourning and death acceptance, Modern Loss is a repository of stories, essays, resources and information about dealing with loss and picking yourself up again!

7. What’s Your Grief

Founded by mental health professionals with 10+ years of experience in grief and bereavement, WhatsYourGrief.com is an excellent resource for anyone dealing with the loss of a loved one. Grief is a complex emotion but one that is completely natural. Rather than try and rush of process of bereavement, WYG encourages their readers to work through their feelings in positive, long lasting ways. Well written blogs, grief resources, how-to’s and more.

6. Connecting Directors

Interested in a first hand account of life in the funeral business? Connecting Directors is a great place to start. It is a collection of news, blogs, articles and marketing information tailored to the funeral profession. While some of it may not be relevant to your interests, there is a lot of great information there(plus we are featured there quite often **cough cough**). Started by Ryan Thogmartin, this website reaches thousands of death professionals and gathers articles from a number of sources.

5. Death Cafe

We couldn’t be bigger fans of Death Cafe! While the internet portion of Death Cafe is only secondary to the actual events, it is a great place to connect with a death positive community. Death Cafe’s are informal meetings that happen all over the world where people get together and talk about life, death and everything in between. Chances are there is a local Death Cafe chapter in your city(and if not, you should probably start one). We have been to two events held by our local Death Cafe and they were incredible! Expect tears, laughter and the unexpected.

4. Death & the Maiden

A newcomer relative the rest on our list, Death Maidens is important for several reasons. First, it is connected to growing death positive/death conscious movement. Second, it highlights the important, historical and growing role that women have played vis-a-vis death and dying. We often forget that women before the 20th century played vital functions in death. They washed and dressed bodies, they were the public face of mourning and they knew death in a way that few of us do today. We are really looking forward to some great and informative content!

3. Confessions of a Funeral Director

It would be no exaggeration to say that Caleb Wilde is almost a household name. People who are in no way connected to the funeral profession know his website and share his content. A 6th generation funeral director and prolific blogger, Caleb started Confessions of a Funeral Director as a window into the death profession. His blog runs the gamut from humour, memes, short stories, advice and of course, secrets from the world of funeral directors. A must read for anyone interested in death awareness!

2.  The Order of the Good Death

Founded and run by Caitlin Doughty, The Order has grown to become much more than a simple blog/website raising death awareness. The order now hosts dozens of members from academics, morticians, funeral directors and artists and is filled with both written content and video content. Caitlin’s well known YoutTube channel, Ask a Mortician, is an informative and hilarious video series. The Order now also runs the largest death positive meet-up in the world, Death Salon. Be careful though as you could get lost for hours on The Order’s website!

1. Death Reference Desk

The Death Reference Desk is run by professor John Troyer, Deputy Director of and a Death and Dying Practices Associate at the Centre for Death and Society at the University of Bath and Librarians Meg Holle & Kim Anderson. Pulling from their knowledge and experience, the goal of the DRD is to inform the casually interested and morbidly curious alike about All Things Death: the bizarre, the batty and the beautiful, from interesting blogs and recommended books to commentary and analysis of death in the news. This website is an incredible resource for anyone interested in almost anything related to death and dying and best of all, you can ask John, Meg & Kim any question and they will answer them on their website! 

Complete Article ↪HERE↩!

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What Is Day Of The Dead, And What Can It Teach You About The Grief Process?

The Mexican holiday has nothing to do with Halloween, but lots to do with normalizing death.

By Kelly Burch

[T]his summer, it seemed like death was everywhere. In the course of a few short weeks I had a miscarriage and watched my dog be struck and killed as we walked down our dead-end road. Two weeks later, my aunt unexpectedly passed away in her sleep.This trio of tragedies would have left anyone reeling, but I realized that I was hurting deeply in part because I didn’t have an adequate vocabulary to talk about death. This was especially evident when I tried to answer questions posed by my 3-year-old daughter, who kept inquiring about our dog and her great aunt for months. I wanted her to understand that death was normal and even expected, but I was having a hard time remembering that myself. (Here are 5 reasons you should talk about death, even if you don’t want to.)

And then, by chance, I stumbled upon information about Dia de Los Muertos—Day of the Dead—and I was captivated. Day of the Dead is most commonly celebrated in Mexico, although other South American countries celebrate as well. It’s believed that spirits arrive on October 31 and leave on November 2. November 1, however, is the main day of celebration, and the day most commonly referred to as Day of the Dead.

Most Americans, if they have even heard of the holiday, associate it with Halloween and colorfully painted skulls. But despite the coincidental timing, it’s really a fun-filled but complex acknowledgement of death as part of life, and it combines the Catholic All Saint’s Day with indigenous traditions and beliefs.

People who celebrate it believe that, on and around November 1, spirits can easily pass between our world and the afterlife. Families might set extra places at the table, exchange stories, and prepare gifts for their deceased loved ones. But mostly the day is about fun, since many people believe spirits would be insulted if they came back to find everyone in mourning.

This seemed vastly different from how many Americans view life, death, and grieving, so I wanted to learn more. It turns out there’s a whole lot that we could all learn from Dia de Los Muertos about the grief process.

Death is a part of life.
I’ve always thought of life and death as opposites. However, Day of the Dead celebrates death as a part of life, rather than the end of it. And recognizing that life and death go hand-in-hand can ease the grieving process, says Kriss Kevorkian, PhD, an expert on grief.

“Day of the Dead connects life and death in a way that, generally speaking, Americans don’t often do,” says Kevorkian. People who celebrate it realize that their loved ones are still present in their lives, even if they aren’t physically there. “You’re not taught to believe that once your loved one dies that’s it.” By normalizing death, the grieving process also becomes normalized and less of something to fear.

A relationship doesn’t end just because someone has died.
“The first chapter of grieving is really recognizing that someone is gone from this world, and your relationship with them is changing” rather than ending, says Tracee Dunblazier, a spiritual empath and grief counselor based in Los Angeles. Whether you believe like Dunblazier does that it’s possible to communicate with the dead, or you merely believe in keeping them alive through memories, recognizing that some sort of relationship can be maintained can be very healing.

“When you think of death as final, you’re looking from a specific sliver of a perspective that does not show the whole story,” Dunblazier says.

Grief doesn’t follow a strict timeline.
When someone you love dies, everyone expects you to struggle—but only for a little while. The problem, of course, is that people don’t heal on schedule, and sometimes it takes months or even years to “move on,” especially after someone passes unexpectedly. This idea is known as complicated grief, and Western cultures usually view it as something to treat (perhaps with therapy and/or antidepressants).

Cultures that celebrate Day of the Dead, however, don’t try to force a sense of closure. Having a holiday that acknowledges the presence of the dead can make complicated grief easier to address, particularly on November 1, when the spirits are thought to be nearby. Believing that your loved ones can hear and understand you on this holiday means that you have the chance to say anything that was left unsaid before they died, says Merrie Haskins, a counselor and psychotherapist based in Minnesota.

Funerals (or at least memorials) can be fun.

In America, death is a very somber event. We wear black to funerals and talk in hushed tones. However, anyone who has ever listened to a lovingly-delivered eulogy knows that smiles and laughter are an important part of the grieving process. Although South American cultures have sad funerals as well, they incorporate happiness and fun into Day of the Dead to honor their loved ones in a more spirited way. That’s something that’s not common in American culture. (See how these 3 alternative therapies can help heal your grief, according to Prevention Premium.)

“We don’t usually have a celebration with levity, happiness, song, and dance,” says Shoshana Ungerleider, MD, chair of the End Well Symposium, an organization that focuses on quality end-of-life care. “People who celebrate the Day of the Dead take this lightness very seriously, due to the belief that spirits who come to visit would be insulted if they found everyone in mourning.”

Haskins suggests adopting that focus on fun as a way to celebrate your loved ones. For example, each year she attends an Academy Award viewing party given in honor of a particular deceased family member who used to love watching the awards show. “That makes it fun for us to remember her and for new people to get to hear about how wonderful she was,” she says.

Stop fearing death, and your own death will be better.
Everyone dies, but many people are too terrified to think about it—to their detriment. “In America, we often shy away from talking about death, loss, and grief. As a physician, I see many gravely sick people in the hospital who have never considered what they want at the end of life,” Ungerleider says. As a result, their final days can be stressful for them as well as their families, because everyone is struggling to make decisions that align with their beliefs while simultaneously dealing with the grief of imminent loss.

A celebration like Day of the Dead can make people think about their own death and plan for what they want at the end of their lives. “By accepting and discussing openly that death is a part of life, you make sure you receive the care you want.”

Complete Article ↪HERE↩!

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A Checklist Before Dying

By

[I]n early 2015, my mom was in a car wreck. She sustained extensive injuries and died two weeks later. I was 35 at the time, surrounded by chaos, and had no idea what I was doing.

You hate to look on the bright side of life-altering tragedy, but I’m still so grateful to my mom for having her affairs in order. Because her accident was so sudden, it took a few days to locate her end-of-life documents. Once we did, it felt like there was a shift in my brain chemistry. We now had guidelines to help us respond to this terrible, traumatic event.

A lot of people believe it’s too difficult or macabre to think about, much less plan for, your own death. But confusion, exhaustion, and terror are the norm in the wake of enormous loss. Planning ahead helps reduce your family’s stress when they’re already in their own personal hell.

If you have a contentious relationship with your family of origin, it’s extra important for you to draw up wills and other relevant legal documents. If something terrible were to happen to you, somebody you don’t like or respect but happen to share blood with may have more say than the people who are actually important to you. Paperwork can help prevent that.

Here is an overview of how to prepare for the (inevitable) worst:

Your Last Will and Testament

Most of us learn about wills from television, though I’m not sure there’s actually ever been a dramatic scene immediately after a funeral where a lawyer sits down with a bunch of people and parcels out the deceased’s belongings.

A will serves two functions:

  1. To appoint an executor of the estate
  2. To express the deceased’s wishes about distribution of assets

It doesn’t matter how much or how little a person had in this world. When they die, their assets and debts become the property of “the Estate of [Deceased Person].” An executor of an estate is the person put in charge of making sure the estate is handled properly—which does sometimes come down to parceling out the deceased’s belongings.

You should know that, even if you say “please leave all my money to these people or this organization,” if you die with a bunch of debt, it’s likely the debt will have priority over your wishes.

A durable power of attorney

This document outlines how incapacitated you have to be to let some (specific) person handle your money. Even if you don’t want anyone else to touch your money, consider the logistics; setting up a power of attorney lets someone else sign checks to pay your light bill or rent, for example, without technically committing fraud. (We always forget about the little stuff.)

You have to specifically appoint a person for this role. Once you die this document ceases to be of any value and the executor of your estate takes over.

Your medical directives

This document lays out the manner in which you wish to live vs. do not wish to live. These documents vary massively by state. In general, states with Right to Die laws will have more much more detailed requirements. If you draft a medical directive in one state and then wind up becoming grievously ill or injured in another state, they should still honor the spirit (if not the letter) of this document.

I did mine in Oregon. It’s a three-page list of yes/no scenarios. You have to consider your own mortality, but other than that, it’s really not that daunting. All you have to do is express what you’d like to happen to you, should the worst happen.

You have to specifically appoint a person to execute your medical directives as well. A doctor will not look at this document and enforce it based on their own judgments about your condition. So make sure the person you appoint to do this is someone who understands your wishes and respects your values, because this document will empower them to either enforce or override your choices.

An estate attorney

A will, a durable power of attorney, and a medical directive should all be drawn up with a lawyer. The people that specialize in this area of the law are called estate attorneys. The estate attorney should be able to tell you upfront how much it will cost to draw these documents up and a lot of times you can work out a payment plan with them.

This attorney will keep a copy of each of these documents in their files. You should also keep copies in a safe place that other people know about and can access should you be in a medical crisis and unable to communicate. It may also be wise to give copies to the people who have appointed roles in your end-of-life documents.

Life insurance

You should have life insurance if you have any outstanding debts or dependents. My understanding is that your life insurance should equal your debt + five years of your salary + your child’s/children’s estimated college tuition, but do your own research on what’s best for you—and do some research on which of your debts are forgiven in death and which are not.

If you have no major debt and no dependents, you could skip the life insurance part, but keep in mind that life insurance beneficiaries can also be parents or other relatives, all of whom could probably use the money—especially if they are anticipating support in their retirement years and/or paying for the cost of your funeral.

Love letters

Any final lovely words you want to write to the wonderful people in your life? Better yet, any petty stuff you want to make sure you get the legit last word on? Write it in a letter, seal it in an envelope and keep with the other documents.

Lists of accounts, important contacts, assets and debts

Accounts: A list of all your credit cards, checking and savings accounts, including where they’re held and branch information if necessary.

Important contact info: The attorney who helped draft your legal documents, your doctor, your health insurance, your pet’s veterinarian, etc. If someone had to suddenly take over your whole life, what do they need to know?

Assets: Retirement accounts, a 401(k) program at your work, any property you might own (with the mortgage holder listed), savings bonds, certificates of deposit, etc. You can leave out the account numbers if you have privacy concerns; what you’re really doing is making a road map for whoever will be handling your affairs.

Debts and bills: Student loans, credit cards, mortgages, auto loans, etc. Don’t forget your rent, utilities, subscriptions, child support, memberships, and donations that auto-renew. List every single thing that bills out of your account monthly, quarterly, annually.

Update this information every time you change your clocks and put the revision date at the top. (Also, change your smoke alarm batteries while you’re at it.)

Funeral preparations and preferences

You can get as specific as you want with this, but at the bare minimum let people know if you want a burial or cremation and where you want your remains to go. (Especially if you come from a large family or if there are any religious or cultural differences to consider.)

Obituary draft

Obituaries have to be filed for a few reasons. Many states have public disclosure laws for debt collection that require an obituary. Also, people might want to come to your funeral (or at least know you died) who aren’t in your immediate social and family circles. Draft a super basic obituary that includes where you were born along with the names of your parents, siblings, children, etc. A few broad strokes about your life, where you went to school, worked, what you enjoyed doing, etc.

It’s going to be painful for your loved ones to write about you in the past tense, so giving them a rough draft can be very helpful—especially because the obituary usually has to be written immediately  after a person’s death.

Make sure people know where this stuff is!

Keep it somewhere secure. But let the right people know how to access it. A fireproof safe in your house? Make sure someone knows where the keys are. A safe deposit box? Make sure someone else has access to it. In a folder on your laptop labeled “Death Prep?” You’d better give someone else the password and the file path. Under the floorboards? Whatever, just make sure people can find it and have access to it if you are suddenly incapacitated.

Final note

The less mess you leave for someone to clean up, the less you’ll complicate the grief for people who love you. All the secrets you have stashed around your life? Someone has to clean that up. Know that the dead have zero privacy; all of your porn, medical history and drug habits will be 100 percent somebody else’s business now. Appoint an executor who has some chill, and good luck in the next plane of existence.

Disclaimer: I’m not a lawyer, nor a financial advisor. I’m terrible at math and I hate dealing with people. This is not professional advice and you should definitely pay an actual grown-up $200/hour to explain how the basic tenets of our society functions because your pain, fear and confusion is the grease that keeps the ruthless machine of capitalism churning. Above all, do not sue me if you mess up your own life!

Complete Article ↪HERE↩!

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Dying a good death—what we need from drugs that are meant to end life

There are a few drugs that can end life, and how we want to die should be considered.

by And

[G]enerally speaking, health care is aimed at relieving pain and suffering. This is also the motivation behind euthanasia – the ending of one’s own life, usually in the case of terminal illness characterised by excruciating pain.

There has been debate in Victoria about the drugs that should be used to end life if euthanasia is legalised. So which medications can we ensure would facilitate the best, medically-supervised death?

Medicine as poison

When it comes to the question of which medicines can, or even are meant to, kill us, the most important thing to remember is the old adage:

“The dose makes the poison.”

This concept is one on which the whole discipline of toxicology and medicines is founded. This is the meaning of the well-known symbol of the snake, wound around the bowl of Hygeia (the Greek goddess of health), representing medicine, which you see in pharmacies and medical centres around the world. The intertwining of poison and is a longstanding concept in the therapeutic use of medicines.

This is a very intricate science, and the reason we conduct clinical research. We need to trial different doses of new drugs to meticulously establish a safe but effective threshold for use.

In more practical terms, this means too much of any medicine can cause harm. Take, for example, the humble paracetamol. When taken following correct guidelines, it is a perfectly safe, effective pain killer used by millions of people worldwide. But taken in excessive quantities, it can cause irreparable liver damage, and if the patient is not given an antidote in a hospital, could lead to death.

What drugs are used in assisted dying?

The group of drugs most commonly used to end life is called the barbiturates. They cause the activity of the brain and nervous system to slow down. These drugs, used medicinally in small doses, can be taken short-term to treat insomnia, or seizures in emergencies. In different doses and administration techniques, these preparations can also be used as anaesthesia, to make us sleep through surgery.

An overdose of barbiturates is fatal. A large dose will effectively make the brain slow down to a point where it stops telling the body to keep the respiratory system working, and breathing ceases.

Both secobarbital capsules and pentobarbital (usually known as the brand name, Nembutal) liquid – (not to be mistaken for epilepsy medication phenobarbital) have been used either alone or in combination for physician-assisted suicide or euthanasia. They are also used in injectable forms for animal euthanasia.

These two products are tried and tested, have the advantage of years of use with the benefit of knowing the exact dose range needed, and with few adverse effects reported (such as unexpected pain, drawn-out death or failed death).

Their safety and efficacy in inducing a peaceful, swift and uneventful death has been proven around the world. They are the preferred drugs in the Netherlands, Belgium, Switzerland and some USA states where euthanasia is legal.

Other options exist, whether in combination or alone, but have limited evidence of use in euthanasia. Some drugs that cause excessive muscle relaxation and respiratory distress can end life, as can some pain killers commonly used in palliative care.

Drugs can also be used that fatally lower , cause heart attack, or block messages from the brain to the muscles, causing paralysis.

While all of these drugs are legally available in Australia, they could cause a long, protracted , with many more side effects that could cause distress and suffering at the end of life. Nembutal and its relatives are less likely to do so, with greater evidence from international practices than any other drugs that can end life.

The ‘best’ death

In Australia, Nembutal and secobarbital can be used for animals, but are illegal for human use. This makes implementation of the newly proposed euthanasia law in Victoria slightly more difficult. The proposed legislation does not seek to legalise the use of Nembutal and its relatives – but suggests a “drug cocktail” be concocted by a compounding pharmacist.

The Victorian government has reportedly approached Monash University’s pharmacy department to research the kind of pill that could be developed if the legislation passes. Therefore, no final description of this product has been released.

Some have suggested the mixture will be in powder form made with to induce a coma and eventually cause respiratory arrest. It may also use sedatives and muscle relaxants, a drug to slow down the heart, and an anti-epileptic to prevent seizure and induce relaxation of muscles. The constituents and doses are yet to be determined.

It’s difficult at this early stage to predict how this concoction would work and whether it would be easier or safer to use than drugs already tried and tested. This proposed product would need to be tested and results compared, as all are.

What is needed is a or a mixture of drugs that produce a painless, relatively quick and peaceful passing. We do not wish to see further suffering in the form of seizures, prolonged distress and pain. If no solution is certain, it would be wise to fall back on simply legalising what is already tried and tested.

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New study looks at end-of-life decision making for people with intellectual disabilities

by Bert Gambini

 
[A] new study by researchers at the University at Buffalo provides a groundbreaking look at how advance care planning medical orders inform emergency medical service (EMS) providers’ experiences involving people with intellectual disabilities.

Most states in the U.S. have programs that allow to document their end-of-life decisions. In New York, the Medical Orders for Life-Sustaining Treatment form (MOLST) allows individuals to document what measures , including EMS providers, should take near the end of a patient’s life.

Studies suggest that this approach to person-centered advance care planning can alleviate a dying patient’s pain and suffering, according Deborah Waldrop, a professor in the UB School of Social Work and an expert on end-of-life care. Yet little research on end-of-life decision-making has been done on the growing population of older Americans with intellectual disabilities, which the American Association on Intellectual and Developmental Disabilities defines as a disability characterized by significant limitations in learning, reasoning, problem solving, and a collection of conceptual, social and practical skills.

Waldrop and Brian Clemency an associate professor of emergency medicine in the Jacobs School of Medicine and Biomedical Sciences, authored one of the first scholarly examinations of how pre-hospital providers assess and manage emergency calls for patients who do not wish to be resuscitated or intubated. Jacqueline McGinley, a doctoral candidate in UB’s School of Social Work, joined their research team and served as first author for their most recent work.

Through a series of interviews with five different agencies in upstate New York, the researchers asked EMS providers specifically how forms like the MOLST shape what they do in the case of someone with an intellectual disability.

“The best available research before our study suggested that as of the late 1990s, fewer than 1 percent of people with intellectual disabilities had ever documented or discussed their end-of-life wishes,” says McGinley. “But with this study, we found that about 62 percent of the EMS providers we surveyed had treated someone with an intellectual or developmental disability who had these forms.”

That disparity points to the need to illuminate this understudied area of how people with intellectual disabilities are engaging in end-of-life discussions, according to McGinley.

She says the EMS providers’ charge is to follow protocol by honoring the documents, their directions and organizational procedures. The MOLST, as its name implies, is a medical order that providers are professionally bound to respect. Their procedures are identical for all emergency calls involving someone who is imminently dying regardless of a pre-existing disability, the study’s results suggested.

But questions remained.

“We heard from providers who wrestled with the unique issues that impact this population, including organizational barriers when working across systems of care and decision-making for individuals who may lack capacity” says McGinley.

There are approximately 650,000 adults age 60 and older in the U.S. with intellectual disabilities, according to Census Bureau figures from 2000. Demographers expect that figure to double by 2030, and triple within the foreseeable future.

Person-centered advance care planning specifically involves the individual in discussions about their health history, possible changes to their current health status and what future options might be available in order to best inform that person’s end-of-life decision-making.

The results, published in the Journal of Applied Research in Intellectual Disabilities, suggest that medical orders largely favor efforts to prolong life. This may be due to a reluctance to discuss advanced care planning in this population. Still, this sociocultural context must be strongly considered as future research explores how people with intellectual engage in end-of-life discussions.

Since January 2016, Medicare pays for patients to have conversations with medical providers. In fact, at least once a year, as part of a service plan through the state, people with have face-to-face discussions with their service providers, according to McGinley, who notes the importance of this built-in opportunity to have conversations about serious illness and the end of life.

“What’s most important in all of the work we do is knowing that people can die badly,” says Waldrop. “We know we can make changes that illuminate some of the uncertainties and improve care for people who are dying. Knowing how forms, like the MOLST, are applied in the field is an incredible step in the right direction.”

Complete Article HERE!