Tag: Death And Dying

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At Death’s Door, Shedding Light On How To Live

By Judith Graham

Nothing so alters a person as learning you have a terminal illness.

Ronni Bennett, who writes a popular blog about aging, discovered that recently when she heard that cancer had metastasized to her lungs and her peritoneum (a membrane that lines the cavity of the abdomen).

There is no cure for your condition, Bennett was told by doctors, who estimated she might have six to eight months of good health before symptoms began to appear.

Right then and there, this 77-year-old resolved to start doing things differently — something many people might be inclined to do in a similar situation.

No more extended exercise routines every morning, a try-to-stay-healthy activity that Bennett had forced herself to adopt but disliked intensely.

No more watching her diet, which had allowed her to shed 40 pounds several years ago and keep the weight off, with considerable effort.

No more worrying about whether memory lapses were normal or an early sign of dementia — an irrelevant issue now.

No more pretending that the cliche “we’re all terminal” (since death awaits all of us) is especially insightful. This abstraction has nothing to do with the reality of knowing, in your gut, that your own death is imminent, Bennett realized.

“It colors everything,” she told me in a long and wide-ranging conversation recently. “I’ve always lived tentatively, but I’m not anymore because the worst has happened — I’ve been told I’m going to die.”

No more listening to medical advice from friends and acquaintances, however well-intentioned. Bennett has complete trust in her medical team at Oregon Health & Science University, which has treated her since diagnosing pancreatic cancer last year. She’s done with responding politely to people who think they know better, she said.

And no more worrying, even for a minute, what anyone thinks of her. As Bennett wrote in a recent blog post, “All kinds of things . . . fall away at just about the exact moment the doctor says, ‘There is no treatment.’ ”

Four or five times a day, a wave of crushing fear washes through her, Bennett told me. She breathes deeply and lets it pass. And no, psychotherapy isn’t something she wants to consider.

Instead, she’ll feel whatever it is she needs to feel — and learn from it. This is how she wants to approach death, Bennett said: alert, aware, lucid. “Dying is the last great adventure we have — the last bit of life — and I want to experience it as it happens,” she said.

Writing is, for Bennett, a necessity, the thing she wants to do more than anything during this last stage of her life. For decades, it’s been her way of understanding the world — and herself.

In a notebook, Bennett has been jotting down thoughts and feelings as they come to her. Some she already has shared in a series of blog posts about her illness. Some she’s saving for the future.

There are questions she hasn’t figured out how to answer yet.

“Can I still watch trashy TV shows?”

“How do I choose what books to read, given that my time is finite?

“What do I think about rationale suicide?” (Physician-assisted death is an option in Oregon, where Bennett lives.)

Along with her “I’m done with that” list, Bennett has a list of what she wants to embrace:

Ice cream and cheese, her favorite foods. Walks in the park near her home. Get-togethers with her public affairs discussion group. A romp with kittens or puppies licking her and making her laugh. A sense of normalcy, for as long as possible. “What I want is my life, very close to what it is,” she explained. And deep conversations with friends. “What has been most helpful and touched me most are the friends who are willing to let me talk about this,” she said.

On her blog, she has invited readers to “ask any questions at all” and made it clear she welcomes frank communication.

“I’m new to this — this dying thing — and there’s no instruction book. I’m kind of fascinated by what you do with yourself during this period, and questions help me figure out what I think,” she told me.

Recently, a reader asked Bennett if she was angry about her cancer. No, Bennett answered. “Early on, I read about some cancer patients who get hung up on ‘why me?’ My response was ‘why not me?’ Most of my family died of cancer and, 40 percent of all Americans will have some form of cancer during their lives.”

Dozens of readers have responded with shock, sadness and gratitude for Bennett’s honesty about subjects that usually aren’t discussed in public.

“Because she’s writing about her own experiences in detail and telling people how she feels, people are opening up and relaying their experiences — things that maybe they’ve never said to anyone before,” Millie Garfield, 93, a devoted reader and friend of Bennett’s, told me in a phone conversation.

Garfield’s parents never talked about illness and death the way Bennett is doing. “I didn’t have this close communication with them, and they never opened up to me about all the things Ronni is talking about,” she said.

For the last year, Bennett and her former husband, Alex Bennett, have broadcast video conversations every few weeks over YouTube. (He lives across the country in New York City.) “What you’ve written will be valuable as a document of somebody’s life and how to leave it,” he told her recently as they talked about her condition with poignancy and laughter.

Other people may have very different perspectives as they take stock of their lives upon learning they have a terminal illness. Some may not want to share their innermost thoughts and feelings; others may do so willingly or if they feel other people really want to listen.

During the past 15 years, Bennett chose to live her life out loud through her blog. For the moment, she’s as committed as ever to doing that.

“There’s very little about dying from the point of view of someone who’s living that experience,” she said. “This is one of the very big deals of aging and, absolutely, I’ll keep writing about this as long as I want to or can.”

Complete Article ↪HERE↩!

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What if psychedelics could revolutionize the way you die?

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My story begins eight years ago, when I was approached by my first client requesting that I supervise her in a therapeutic session with a psychedelic medicine.

She had debilitating depression and anxiety brought on by a breast cancer diagnosis. Although she had survived her cancer, she couldn’t shake her terrible emotional distress. She had tried therapists, pills and a residential program. Nothing had worked.

Then she came across stories in the media about research at UCLA using psilocybin (the active ingredient in magic mushrooms) with cancer patients suffering from what was called “end-of-life distress” and how this new treatment was showing really promising results.

She was desperate to try it for herself.

Well, as a licensed therapist and academic, could I help this woman? Reading the research literature, I learned that psychedelic research was becoming well-developed as a treatment for the psycho-spiritual depression and “existential anxiety” that often accompany the diagnosis of a life-threatening illness.

I also found myself in a bind: The science was telling me that psilocybin is the treatment most likely to benefit patients with existential anxiety when other treatments have failed; my ethical code from the B.C. Association of Clinical Counsellors tells me to act to my client’s benefit; federal law forbids me to use this treatment.

This is why, together with colleagues in the Therapeutic Psilocybin for Canadians project, I filed an application with Health Canada in January 2017, seeking a so-called “Section 56 exemption” — to permit us to provide psilocybin-assisted psychotherapy to patients with terminal cancer.

Immediate decrease in death anxiety

Dinah Bazer found relief from cancer anxiety by being treated with a dose of psilocybin administered by a New York University study.

Recent research at Johns Hopkins Medical Centre and New York University indicates that treatment of this end-of-life distress with psilocybin-assisted psychotherapy is safe and effective.

The research indicated it led to immediate, substantial and sustained decreases in depression, death anxiety, cancer-related demoralization and hopelessness.

It resulted in increased quality of life, life meaning and optimism. And these changes had persisted at a six-month follow-up.

Patients attributed improved attitudes about life and death, self, relationships and spirituality to the psilocybin experience, along with better well-being, life satisfaction and mood.

It is heartening to see research moving into Phase 3 clinical trials that will involve many more research participants. However, the foreseeable future for Canadians who need this game-changing therapy is not especially rosy.

At our current rate of progress, it may well still be years before psilocybin successfully completes Phase 3 trials and becomes available as an orthodox medicine.

Therapists risk criminal penalties

In the meantime, many Canadians with terminal cancer are also suffering from end-of-life distress, and are in dire need of relief — now.

They face serious and life-threatening illness. Their condition is terminal, so concerns about long-term effects of psilocybin are not relevant. They suffer from serious end-of-life psychological distress (anxiety and depression) to the point that it interferes with their other medical treatments. And this distress has not successfully responded to other treatments.

Psilocybin is currently a restricted drug, meaning that therapists risk criminal penalties if they aid or abet its possession. That means that we cannot recommend or encourage its use.

My professional Code of Ethics, however, states that our ethical duty is to act in a way that serves our clients’ “best interests.” The service we provide has to be “for the client’s benefit.” We must “take care to maximize benefits and minimize potential harm.”

A compassionate, humanitarian death

I agree with the Canadian medical establishment that, in ordinary circumstances, new medicines should be made available to Canadians only when they have successfully completed Phase 3 clinical trials.

In the New York University study a pill, containing either a placebo or psilocybin, was presented to the subjects in a chalice.

But I contend that the patients described here are not in ordinary circumstances. They have terminal cancer. All other treatments have failed them; they have nothing left to lose. They have the right to die; surely they have the right to try!

These patients deserve access to a still-experimental but promising medicine on compassionate and humanitarian grounds. Because of their extraordinary medical straits, psilocybin now for them represents a reasonable medical choice; it is necessary to them for a medical purpose.

Our application to Health Canada seeking a “Section 56 exemption” will be ruled on very shortly.

We fully expect that it will be denied — for political, not scientific reasons. Justin Trudeau’s Liberal government is likely in no mood to loosen up on psychedelics before the dust from the legalization of cannabis has fully settled. I think the government would like it if someone else made that decision.

Violation of our rights and freedoms

If our application is denied, we intend to file for a judicial review, and if necessary, a lawsuit in Federal Court challenging that denial.

We believe that prohibition of access to psilocybin for a legitimate medical purpose violates a citizen’s Canadian Charter of Rights and Freedoms Section 7 right to “life, liberty and security of person.”

This clause has already been interpreted by the Supreme Court to imply that a citizen has the right to autonomy in making health-care decisions. Charter-based arguments have already led to success in three recent landmark medical cannabis cases.

We argue that what applies to cannabis also applies to psilocybin:

The prohibition of … cannabis “limits the liberty of medical users by foreclosing reasonable medical choices through the threat of criminal prosecution. Similarly, by forcing a person to choose between a legal but inadequate treatment and an illegal but more effective one, the law also infringes on security of person.” Supreme Court of Canada, R. v. Smith, 2015

One thing that unites all of us human beings is that we will die. Imagine if, when our time comes, we could all have the option to die peacefully, with acceptance, without anxiety.

Complete Article ↪HERE↩!

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Bizarre, Brutal, Macabre And Downright Weird Ancient Death Rituals

Hercules Fighting Death to Save Alcestis’ (1869-1871) by Frederic Leighton, 1st Baron Leighton.

By ashley cowie

Any parent must agree that one of the greatest hardships experienced around the death of a family member is having to explain to children what happened and what happens next? Should you tell them the stark truth; that the fun and games don’t last forever? What sort of words will you use; dead, died, passed away, lost, crossed over, or went to sleep? This is a problem with very, very ancient origins. Ancient death rituals offer up evidence for this.

Since the beginnings of civilization, whenever and wherever, parents have had to teach their children how to grieve, commemorate, and dispose of deceased loved ones. And in the ancient world death was an infinitely more complicated affair, evident in the bizarre death rites practiced from culture to culture around the world. Here are some of the oldest funeral rituals in history, ones that take death to a whole new level of macabre.

Zoroastrian Sky Burials

Zoroastrianism; the ancient pre-Islamic religion of modern-day Iran, was founded about 3500 years ago and still survives today in India, where the descendants of Iranian (Persian) immigrants are known as Parsees. A 2017 article by scholar Catherine Beyer, Zoroastrian Funerals, Zoroastrian Views of Death, describes the first step in Zoroastrian funeral rites, where a specially trained member of the community cleansed the deceased “in unconsecrated bull’s urine.” The corpse was then wrapped in linen and visited twice by ‘Sagdid’ – a spiritually charged dog believed to banish evil spirits – before it was placed on top of the ‘Dhakma’ (Tower of Silence) to be torn apart and finally devoured by vultures.

A 1938 photograph showing the aftermath of a ‘Sky burial’ from the Bundesarchiv.

Tibetan Buddhist Celestial Burials

Similarly to ancient Zoroastrians, today, about 80% of Tibetan Buddhists still choose traditional “sky burials.” This Buddhist ritual has been observed for thousands of years and it differs from the Iranian/Indian rituals because the deceased were/are chopped up into small pieces and fed to birds, rather than being ‘left’ for the birds.

While at first this might seem nothing short of brutal, verging on undignified, a research article published on Buddhist Channel explains that Buddhists have no desire to commemorate dead bodies through preservation, as they are thought of as shells – empty vessels without a soul. What is more, in their doctrines, which promote ‘respect for all life forms’, if one’s final act is to sustain the life of another living creature the ritual is actually a final act of selfless compassion and charity, which are primary concepts in Buddhism.

Drigung Monastery in Maizhokunggar County, Lhasa, Tibet was founded in 1179 AD. Traditionally it has been the chief seat of the Drikung Kagyu tradition of Tibetan Buddhism and it is famous for its performance of ‘sky burials’.

Native North American Totem Poles

Native cultures in the American Northwest carved wooden Totem poles to symbolize the characters and events in myths and to convey the experiences of living people and recently deceased ancestors. The Haida people from the Southeast Alaskan territories tossed their dead into a mass grave pit to be scavenged by wild animals.

However, Marianne Boelscher tells us in her 1988 book  The Curtain Within: Haida Social and Mythical Discourse that the death of a chief, shaman, or warrior, brought with it a complex and bloodthirsty series of rituals. Dead shamans, who were thought to have cured the sick, ensured supplies of fish and game, and influenced the weather, trading expeditions, and warfare, were chopped up and pulped with clubs so that they could be stuffed into suitcase-sized wooden boxes. Once pressed inside, the boxes were set atop mortuary totem poles outside the deceased shamans’ homes to assist their spirits’ journey to the afterlife.

Wooden totem poles at the Skidegate Indian Village of the Haida tribe. Skidegate Inlet, British Columbia, Canada, 1878.

Endocannibalism

Known to anthropologists as “endocannibalism” many ancient cultures disposed of their dead by eating them . Herodotus (3.38) first mentioned ‘funerary cannibalism’ as being practiced among the Indian  Callatiae people. Furthermore, the Aghoris  of northern India were said to “consume the flesh of the dead floating in the Ganges in pursuit of immortality and supernatural power,” according to an article published on Today.

The ancient Melanesians of Papua New Guinea and the Wari people of Brazil both held “feasts of the dead,” where they attempted to “bond the living with the dead” and to express community fears associated with death. Some specialists believe that endocannibalism is something the dead might have expected as a final gesture of goodwill to the tribe and their direct family.

Painted by Charles E. Gordon Frazer (1863-1899), ‘A cannibal feast on Tanna, Vanuatu, New Hebrides’, c. 1885–1889.

Sati – Burning The Widow

Sati (suttee) is an ancient funeral custom practiced by the Egyptians, Vedic Indians, Goths, Greeks, and Scythians. Banned mostly everywhere today, Sati required widows to be burnt to ashes on their dead husband’s pyres; sometimes voluntary ending their lives, but there are many recorded incidences of women being forced to commit Sati, which is murderous, inconceivable, and beyond any reason.

Robert L. Hardgrave, Jr. is Temple Professor Emeritus in the Humanities, Government and Asian Studies, The University of Texas at Austin. In his informative book The Representation of Sati: Four Eighteenth Century, the Sati ritual is considered as having maybe originated to “dissuade wives from killing their wealthy husbands” and it was sold to the public as a way for husband and wife to venture to the afterlife together.

A Hindu widow burning herself with the corpse of her husband, 1820s, by English illustrator Frederic Shoberl.

Sacrificial Viking Slaves

While the threat of a Sati ritual must have utterly terrified Hindi women of all ages and creeds, the death of an ancient Scandinavian nobleman, according to Ahmad ibn Fadlan, a 10th century Arab Muslim writer, brought funerary events of an “exceptionally barbaric nature.” After the death of a chieftain, his body was placed in a temporary grave for ten days while a slave girl was ‘selected to volunteer’ to join him on his passage to the afterlife. The sacrificial maiden was forced to drink highly intoxicating, psychedelic mushroom enhanced drinks, and as a way “to transform the chieftain’s life force” she was forced to have sex with every man in the village who would all say to her, “Tell your master that I did this because of my love for him.”

A 2015 Ancient Origins article written by contributor Mark Miller titled The 10th century chronicle of the violent, orgiastic funeral of a Viking chieftain explored these rites in detail and explained that after what amounts to constitutionalized ‘rape’, the girl was taken to another tent where she had sex with six Viking men. The last man strangled the girl with a rope while the settlement’s matriarch ritually stabbed her to death. The chieftain and his slave girl were finally placed on a wooden ship to take them to the afterlife.

The deceased chieftain and slave girl were sometimes incinerated within a symbolic stone built ship. This example is situated at Badelunda, near Västerås, Sweden.

Somewhere Between The Above And The Below

In 1573 AD, the Bo people of southern China’s Gongxian County were massacred by the Ming Dynasty and are today all but completely forgotten, if not for their mysterious 160 hanging coffin baskets located almost 300 feet (91 meters) high on cliffs and in natural caves above the Crab Stream. A China.org article informs that locals refer to the ancient Bo people as the “Sons of the Cliffs” and “Subjugators of the Sky”, and murals surround the coffins that were executed with bright cinnabar red colors illustrating the lifestyles of the ancient slaughtered people.

One of the hanging tombs of the Ku People at Bainitang ( 白泥塘), Qiubei county, Wenshan prefecture, Yunnan province, China.

What Can We Learn from Ancient Death Rituals?

Having skirted over some of the ancient world’s death rituals, we are now hopefully better equipped to answer those questions that our children will inevitably ask us. You might be well served to offer your child the words of author Robert Fulghum: “I believe that imagination is stronger than knowledge. That myth is more potent than history. That dreams are more powerful than facts. That hope always triumphs over experience. That laughter is the only cure for grief. And I believe that love is stronger than death.”

Complete Article ↪HERE↩!

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Having fun while sharing your wishes is an appealing way to discuss end of life

By Robin Williams Adams

The three sisters came to Lakeland Regional Health for what they thought would be a lecture.

Being retired educators, they’ve heard a lot of those.

Instead, they gathered in small groups to play a game with card-sized booklets and chips, laughing as they answered some questions asked and looking pensive as they thought about others.

“It gets to your emotions and thoughts,” said Janie Rambert, 61.

“You hear what other people have to say and it makes you think.”

Programs about advance directives, living wills and the like can come across as a thou-should-do-this talk.

Some may convey the benefits of those documents, but fall short at helping you start conversations about your wishes for medical care and support from family or friends if you become ill or incapacitated.

Colinette McGriff, 65, said she’d been holding back on having an advance directive or living will.

“I put it off because it seemed negative in a sense,” she said.

“The older I get, I think, ‘I should have done it years ago because I don’t want it on my kids.’”

Fewer than 4 in 10 people in the United States, about 37 percent, complete any kind of directives, concluded an analysis published in the July 2017 issue of Health Affairs.

How to make the numbers increase is a major goal of the Rev. Eileen Stone, a chaplain at Lakeland Regional; others involved in palliative care; and Lauren Springfield, manager of its community health program.

They invited members of Harmony Missionary Baptist and New Mt. Zion Missionary Baptist churches, along with community members, to the Hello Community Game Day held Sept. 29.

Middle sister Trudy Williams, 63, said she came hoping the program would “awaken me to my true feelings about how I actually feel.”

At the end, she and her siblings agreed, it helped achieve that.

“I’m going to discuss more with my husband and family about what I want to do and see how they feel about it,” Williams pledged.

They played “Hello,” a Common Practice conversation game. Participants write answers to questions and share their answers with others in their small groups.

Springfield and Stone called it “a game about living and dying and what matters most to each person.”

 

The teal-blue booklets in which they answered questions were for use with Project Talk, Conversations that Matter, a research program at Penn State Milton S. Hershey Medical Center.

The Hospice Foundation of America chose Lakeland Regional as one of 15 organizations to take part in research for a project the foundation is doing with Penn State Health.

People first wrote down any fears they may have had about playing the game and what they hoped to learn from it.

“I wanted to learn more about living wills and regular wills because we travel on the highway a lot,” Rambert said.

Then it was on to questions like what you would do if you knew you had three months to live, non-medical facts you would want a doctor to know about you; and who you would want to sing at your memorial service if you could choose anyone in the world.

Would you want your healthcare team to know your religious or spiritual beliefs?

Do you worry more about not getting enough care at the end of life or about getting too much?

What music do you want to be listening to on your last day alive?

Those were some of the questions in the booklets, which participants were able to take home.

There were no wrong answers. People could change their minds.

The chips given each person could be gifted to fellow participants for insightful, emotional and moving answers.

Not all questions got answered that day. The sisters, who taught in Polk County schools, said they plan to consider them further and talk about them with others.

Rambert, contacted Oct. 22, said she found her husband, Dwayne, more open to doing it than she was.

“You have to have someone there to keep you directed,” she said.

Springfield said she would like to help arrange other Hello game days at local religious institutions.

“People feel more comfortable coming to events at churches than they do at the hospital,” she said.

Complete Article ↪HERE↩!

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Choosing your own exit.

For some who are terminally ill, hastening their own death may be the answer.

By Samuel P. Harrington

Four months before he died, my father, a widower of six years and a hospice patient, asked me to discuss techniques for hastening his death, although he did not use that term: “I have lived too long. What can I do?”

He was living in Wisconsin where medical aid-in-dying, which allows terminally ill patients to obtain a lethal dose of medicine from a physician, was not legal. At first, I was afraid that he was asking me, a physician, to go around the law and supply him with a lethal dose of sedatives. Fortunately, he was not. He was dying of lymphoma and geriatric “failure to thrive” (old age), but it was a slow and unpleasant process. What could he do, he wanted to know, to move things along? He was ready

It was Christmas Day and I was cooking a few of my mother’s traditional dishes. Gradually, and recognizing the irony of simultaneously baking his favorite pie, I eased into a conversation about refusing to eat and drink. We had had this conversation in the past and it always ended the same way. Unlike most of my terminally ill patients, my father had not lost his appetite and would not give up the pleasure that food brought him.

The next day, he had come to decision: He would no longer take any medications designed to prolong his life, he announced to his family, caregivers and hospice nurses. These included heart pills, blood pressure pills and electrolyte supplements. He would, however, continue palliative medications, including tranquilizers and pain pills. My father died painlessly exactly four months later from the effects of multiple ministrokes.

According to the Center for Disease Control and Prevention, 90 percent of people over age 65 die of six chronic illnesses (heart failure, cancer, lung disease, stroke, dementia and diabetes). If I am fortunate enough to live to a ripe old age, I expect that I will suffer from one of these illnesses. If treatments are ineffective and a prolonged dying process is intolerable, perhaps I, like my father, will want to hasten my death.

As a doctor, I have found that having a sense of some control at the end can be reassuring to people. Yet it’s not easy — nor should it be — for someone to say, “I’m ready to be done with this,” and then have it be so.

In general, three ways are available where a terminally ill patient can speed up the process of dying without the assistance of someone else. One is by declining (or discontinuing) medical treatments that prolong life without improving the quality of life. Stopping his non-palliative medications was my father’s variation on this theme.

Another approach is to refuse to eat or drink. Known as voluntarily stopping eating and drinking, VSED (pronounced “V-said”) is an effective technique that takes advantage of the natural tendency for the terminally ill to lose their appetite to the disease process. This means that there are minimal hunger pains. Patients die of dehydration, which sounds bad but dehydration, by itself, is a pain-free condition. Most people have easily managed symptoms of thirst that stop as things progress. About 10 percent have significant, hard-to-manage symptoms of thirst. Most people slip into a coma in two to four days and pass away in 10 to 14 days.

The third approach is to take a lethal dose of medication. Medical aid-in-dying is legal in seven states and the District. The vast majority of terminally ill patients who choose to exit life this way slip into a coma in minutes and die painlessly within hours.

Having tended many terminally ill patients, I’ve often wondered what I would do if faced with a prolonged death from a chronic illness. If told I had less than six months to live, I would certainly enter hospice care, where the focus of doctors and other health-care professionals is on preserving quality — not quantity — of life. But then what?

Discontinuing or declining medical treatment includes everything from refusing life support or turning it off after a catastrophic stroke, infection or heart attack to discontinuing a pacemaker, a feeding tube or kidney dialysis.

It can also mean no antibiotics for a pneumonia or bladder infection in a bedbound hospice patient. Comforted by palliative treatments — narcotics and sedatives that induce comfort and sedation — any of these decisions will result in a comparatively comfortable death.

My quandary with this method for hastening death is that it relies on the random development of a disease or complication (stroke, infection or heart attack, for example). It is not a proactive strategy offering a better sense of control.

Medical aid-in-dying is proactive and it is effective. It is an option that I believe people should have available to them. Yet it comes with an unanticipated scheduling complication that gives me pause.

The laws allowing medical aid-in-dying are written to protect chronically ill patients from impulsive decision-making, coercion and premature deaths. Most require that patients themselves initiate the process; be certified by two physicians as terminally ill (defined as a life expectancy of less than six months) and mentally competent (without serious depression); undergo a two-week waiting period between the time of certification and acquisition of the medications; and remain mentally competent and physically capable of self-administration at the time of ingestion.

One woman I interviewed lives in Oregon, where medical aid-in-dying has been available for more that 20 years. Her story epitomized the scheduling conundrum.

When her husband was dying of rapidly progressive cancer, they scheduled a family gathering at which time he planned to take his lethal potion. One week before the event, progressive disease threatened his ability to self-administer the medication and they had to hurriedly reschedule with their children and the end-of-life volunteers who mix the medications and witness the process. One son could not reschedule. The wife felt rushed and disappointed that her son could not make it in time.

That scheduling artifice bothers me and supports the nagging sense of prematurity that I associate with many aid-in-dying deaths.

Yet if I lived in a state where it was available, I would consider it, particularly under two conditions: If I were suffering from poorly controlled pain or if I could not be kept clean because of uncontrollable incontinence. (I have seen this in men and women who have suffered complications from pelvic radiation, surgery or cancer itself.)

For me, under most circumstances, that leaves VSED. It cannot really be premature or impulsive. It accelerates the body’s natural decline. And it takes 48 to 96 hours of self-controlled commitment before the patient slips into a self-propagating coma. It would offer me control and demonstrate to my family that my death is appropriate and appropriately timed.

How I will face the final phase of my life is of course unknowable. But I am sure that a sense of control is the most important attribute of a good death and that advance care planning helps more patients achieve their end-of-life wishes.

I know that I do not want to be a burden on my family. I want my values and my legacy to be affirmed and appreciated. I want to be clean and comfortable. I want to optimize my relationships and bring closure to as many problems as possible. And I want my death to be appropriate in time and place.

To achieve all this requires discussions with doctors, family and friends. It also requires understanding one’s disease and likely prognosis and then deciding when to say “no” to aggressive treatment and when to say “yes” to hospice care.

These are not easy conversations or decisions. Yet to reach the peaceful end that most of us wish for, one might require a plan to hasten the process.

Complete Article ↪HERE↩!

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Why we shouldn’t fear dying alone, or monothanatophobia


The sunrise burns off the morning mist over the remains of trenches in the Newfoundland Memorial Park at Beaumont Hamel on November 09, 2018 in Albert, France.

by Deirdre Pike

Despite growing up in a death-denying culture, place and time in Canada, pretty long past the days where dead bodies were openly displayed and waked at a family home instead of a funeral home, I have come as far as my 57th year (starting this week) with an openness to conversations about death and dying not normally heard among my peers.

There are many experiences that may have contributed to this. Perhaps being born in November, the Month of the Dead, just two days after Remembrance Day, had an impact. Being named after Ireland’s Deirdre of the Sorrows (not intentionally, my mom assures me) who is said to have died by suicide, perhaps by having her head smashed on a rock by the passing royal chariot (nice touch), may have played a part in my ability to banter about death more freely than others.

Becoming a Catholic, when I was 15, introduced me to ways of ritualizing death and praying for the dead just in time to help me cope with the deaths of seven of my high school peers in three separate car accidents and my stepbrother’s death by suicide a year later.

I also credit my love of excellent rock music for giving me a healthy outlook on death. Take Pink Floyd, for instance.

“And I am not frightened of dying, any time will do, I don’t mind. Why should I be frightened of dying? There’s no reason for it, you’ve gotta go sometime.”

Lying in bed (just like Brian Wilson did) as a teenager, falling asleep, high, with giant headphones blasting these lyrics into my brain, coupled with Trooper’s, “We’re here for a good time, not a long time,” has pretty much described my approach to death, and therefore life, or my approach to life, and therefore death.

It’s that approach, 14 years of parish ministry and more that I have been bringing to what’s called a “Social Innovation Lab.” In this case, the laboratory includes 25 or so palliative care clinicians, social activists, consumers, policy and system leaders, health care leaders and change agents from across Canada to concentrate for six solid days on one question: “How can we change the culture of our health system so the palliative approach, which creates a truly person-centred system, becomes the norm across the whole system?”

This “Palliative Care and Complexity Science Laboratory” is what brought me to be sitting in a circle of a dozen or so residents from a local seniors’ apartment building with three palliative care doctors, discussing monothanatophobia — the fear of dying alone. Although the word itself was brand new to me and all of the people who accepted our invitation to come and discuss it, the concept wasn’t.

We chose our topic after reading about the man who died alone in Hamilton’s social housing recently and went undiscovered for a couple of days before a woman below found some of his remains leaking into her apartment. Nobody wants that to be the story of their last days alive — or dead — on Earth.

There is strong evidence to show why we need to be more intentional about building community now and in the days ahead. Data about living situations from the 2016 Canadian census show for the first time that the number of one-person households has surpassed all other types of living situations. More than a quarter of all households were people living alone.

Applying the principles of palliative care means having conversations about living, not dying. It’s more than making sure community exists to support people in their final days of life. It’s also making sure people are connected while they’re living in a way that respects privacy yet decreases social isolation so no one dies alone.

One great read I recommend on the topic of death and dying is “Talking About Death Won’t Kill You,” by Dr. Kathy Kortes-Miller.

With an essential chapter for anyone on social media called, “Posting, Tweeting and Texting: Dying in a Digital World,” I urge you to make this a holiday gift to your family so you can “out” the conversation of death and dying to make it, as Kortes-Miller says, a logical extension of our living.”

Complete Article ↪HERE↩!

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A Place for Death in the Life of the Church

What does faithful ministry look like in a church that sees more funerals than baptisms?

BY Cole Hartin

I remember the first time I touched a dead body. It was at my grandfather’s funeral. You know the scene: attendants in boxy black suits, the cloying scent of flowers, tissue boxes, breath mints, dusty funeral parlor furniture. As the sad murmur of relatives droned all around, I stepped up to the coffin and quickly reached in to touch his embalmed hands, folded nicely on his belly. They felt like cold, soft leather.

That was when death was still an anomaly to me, an outlier. Now it has become familiar, a recurring pattern in recent weeks and months. For the past several years, I’ve served as a pastor in a suburban parish, an evangelical who made his home in a mainline church. I don’t run the show, since I’m a lay pastor, but I’ve been there for most of the funerals. In the past few years we’ve had almost 40 in our parish. Those are a lot of faces I won’t get to see any more on Sunday mornings. Death is no longer a stranger to me; it is a regular part of my life.

This has been one of the more difficult parts of being a pastor, seeing people who faithfully served our Lord over decades take ill and start a steep decline. These deaths don’t have the shock of tragedy, of teenagers hit by cars or babies born without breath. Still, the dull ache of sorrow is there.

It wasn’t always this way for me. I grew up in a thriving megachurch (by Canadian standards, anyways), and I took it for granted that slowly and surely our congregation would continue to expand. And it did, all through my teen years. As I looked out over the congregation on Sunday mornings, I could see a diverse group of people from ages 15 to 60. But children were most often annexed to their age-appropriate ministries, seniors were few and far between, and funerals were not a constant. The bulk of our congregants were in the prime of life.

Later, when I began my pastoral ministry in a congregation that skewed to those over 65, I became frustrated as our church struggled to thrive. Growth no longer just seemed to happen. And though we saw many young families drawn deeper into the life of Christ, we also lost many veteran saints. I learned to care for the very young as our nursery filled up, and I learned to walk with the aging as they lost the strength to sit in our pews.

Though I looked longingly at congregations that seemed to expand effortlessly, I learned to love the slow work of pastoring a struggling congregation. I took in the beauty of a woman in her 80s dancing with toddlers and singing worship songs. And I remember the 70th wedding anniversary of a couple that faithfully attended worship for just as many years. These quiet miracles don’t have the same luster as other “vibrant” ministries I’ve been a part of, but nonetheless, they witness to the patience and love of God. I came to appreciate the church as the body of Christ formed of the whole people of God, from young to old—even those heading to their graves.

Pastoring an Aging Congregation

Death does not fall outside the life of Christ’s Body; it is a threshold through which we all must walk. Recognizing death as part of our common Christian life allows for a more expansive vision of God’s redemption, which begins the day we are conceived and carries us into our dying

I’ve come to appreciate my close experiences with death. When I look at large, booming churches or hip, thriving church plants, I wonder if their pastors experience the regular privilege of burying octogenarians. I’m glad for these growing churches, insofar as people are having encounters with Christ and his Word. I wish so many of the churches in my denomination would thrive like that. Yet I’m learning to appreciate aging congregations like my own in which the whole community of faith mourns with the death of each faithful servant.

I recently read Kate Bowler’s book, Everything Happens for a Reason: And Other Lies I’ve Loved. Bowler was diagnosed with stage IV colon cancer at age 35. She was enjoying a vibrant career, academic success, and a wonderful home with her husband and toddler. The news of her cancer seemed to crush all of that. Life had to be put on hold for chemo, rest, and preparation for dying.

She writes in her memoir about churches in which blessings come as the direct result of fierce faith. She writes, “The prosperity gospel is a theodicy, an explanation for the problem of evil. It is an answer to the questions that take our lives apart. … The prosperity gospel looks at the world as it is and promises a solution. It guarantees that faith will always make a way.” Bowler writes that she tacitly held to a tamer form of prosperity gospel logic. She expected that, if she followed Jesus, things would go pretty well because God loves her and wants her to have a good life.

I often find myself believing the same thing about my church: if we worship Jesus and do his will, he will bless us with new members and increased vitality. Stagnant membership and death in the congregation feel like punishments for lack of faith.

But God throws wrenches in the wheels of our theological systems. We get fired. We get divorced. We get sick. We die.

Our local congregations lose their liveliness. They suffer from conflicts. They struggle to raise funds. They shrink

Christians believe that “death is swallowed up in victory” (Isa. 25:8, 1 Cor. 15:54). Our faith is built upon the fact that Christ has died, Christ is risen, and Christ will come again. But our experience of death is not always so straightforward. Our sojourn still leads to our bodies being cremated or placed in a coffin.

Helping People Reckon with Death

In many churches I’ve attended, death was pushed to the margins. It was treated like an interruption to God’s work in the world, not as an instrument by which God draws people more fully into his own life. I’m not saying we should love death—after all, it’s still “the last enemy” (1 Cor. 15:26). But part of living as disciples is learning to die well.

Ephraim Radner, professor of historical theology at Wycliffe College, writes,

“To die well” is to locate what is good somewhere outside our control—in the God who gives and receives our lives. It is also to allow that alien goodness, the goodness of God’s transcendent superintendence over life and its temporal duration, to inform the very meaning of our vulnerability to illness, suffering, and death.

In other words, by embracing death in our churches, we allow our creator to give meaning to our human weakness.

Stanley Hauerwas notes in God, Medicine, and Suffering that Western culture shifted from preparing Christians to die well in the medieval period to franticly attempting to cure us from death in contemporary society. He writes, “We have no communal sense of a good death, and as a result death threatens us, since it represents our absolute loneliness.” According to Hauerwas, we need to learn once again how to grapple with our mortality.

Stories like Bowler’s, then, make me wonder about the kind of church we ought to be. What might it mean to be a church where people regularly come face to face with death? How can we present the gospel in a way that changes hearts, but also ministers to people whose earthly lives will never return to “normal?”

One way in which pastors can deal with death is by talking about it openly in sermons and in conversation. I remember talking with a friend who has since passed away from cancer. He told me that many of the Christians he encountered didn’t want him to talk about the possibility of death. They wanted him to stay positive, focusing on things he could do to get better. He knew that he wouldn’t, but he felt the pressure to stay positive for the sake of others. When I talked frankly with him about the possibility of death, he seemed to breathe easier. In naming death, he allowed the grace of God to come to him even there.

We talk about illness and aging as “battles”; to die is to lose these battles. But staying alive is a battle we all lose eventually—some quickly, some slowly—so we might as well invite God’s presence into our dying. In the cross we understand our living and our dying. What better place to learn this than the church? Who better to initiate these conversations than pastors? Sure, I want my church to be dynamic, vibrant, growing; I pray to God for this. But I also want to cultivate a church where people can reckon with death, worshiping a savior who won his victory hanging from nails pinned to a wooden cross.

Complete Article ↪HERE↩!