Death And Dying – Page 296 – The Amateur's Guide To Death & Dying

October 9, 2016October 7, 2016

In facing death, this doctor sees a way to live well

Dr. BJ Miller does not work to heal patients, but to ensure quality of life amid advanced or serious illness. Sometimes people suggest his job is depressing, but Miller doesn’t see it that way. When people are dying it changes how they live, he says. Miller gives his Brief but Spectacular take on dying and living.

JUDY WOODRUFF: Now to another of our Brief But Spectacular series, where we ask interesting people to share their passions.

Tonight, we hear from BJ Miller, a palliative care doctor in the San Francisco Bay Area. He explains how working in end of life care can help inform the way we live.

DR. BJ MILLER, Zen Hospice Project: When people find out I’m in palliative care, first of all, many people — you start with, well, oh, well, what is that? The interdisciplinary pursuit of quality of life, and the context is always advanced or serious illness.

Palliative care is irrespective of the clock. You don’t have to be dying anytime soon.

The curiosity from the public tends to be — and I hear this all the time — wow, you know, that must be so depressing. You know, you must be depressed all the time.

It’s not always happy, by a long shot, but there is this side effect that seems to come. By facing mortality, it seems to inform how you live. So, the secret is that facing death has a lot to do with living well.

The whole reason I went into medicine was because I became a patient. In college, sophomore year, my dear friends and I were horsing around one night. We decided to climb a parked train. I happened to have a metal watch on, and the — and, when I stood up, the electricity arced to the watch, and that was that.

It was sort of an introduction to my own death, my own sense of mortality, my own finiteness.

You’re the object of a lot of sympathy, pity, a lot of head-tilts. At first, it’s kind of sweet, but then it starts turning a little saccharine. You quickly look down that road, and it’s not too long before you realize that’s a dead end. That’s just another way of removing yourself or being removed from the flow of society.

One of the ways that I got through some of the early days was insisting that this was a variation on a theme we all experience, and that theme is — basically is suffering. Some way, life is not going to do what you want it to do. Your body is not going to do what you want it to do. You will suffer. It’s unavoidable.

And there is this unnecessary rind of suffering, which is so — which is the demoralizing part, because it’s the invented stuff. It comes in terms of how we treat each other, sometimes poorly. It comes in those moments of abandonment.

We end up warehousing folks who are sitting on piles of wisdom and experience and just plain hilarious or good stories. If we could sort of shift that a little bit, there’s a lot more peace waiting for all of us as we age.

I think a lot of us are really worried, not so much about the fact that we die, but how we die. Very often, patients themselves, the people doing the dying, will get to a place of acceptance, beyond acceptance even, you know, ready to go. You’re done. You’re done with this body.

A lot of the effort, my effort, the team’s effort, the hospice organization’s effort, is actually not so much on the patient, the person doing the dying. It’s on the family.

In a way, it’s harder to accept the death of another person than accept your own, especially when you really love that person.

I’m BJ Miller. And this is my Brief But Spectacular take on tying dying and living.

JUDY WOODRUFF: You can watch additional Brief But Spectacular episodes on our Web site, PBS.org/NewsHour/Brief.

Complete Article HERE!

October 9, 2016October 8, 2016

A ‘sacred moment’: Brockville doctor talks about why he helps people die

By Joanne Laucius

Dr. Gerald Ashe has seen the kinds of things people do if they can’t get help in dying.

A couple of his patients have taken their own lives. Some have told him they are hoarding sleeping pills “just in case.” He says he has seen too many cases of terminal delirium, a condition where an agitated and confused dying patient survives through five to seven days. The patient will die, it’s just a matter of how long it will take.

“It’s common and it’s nasty and it requires palliative sedation. If given the choice, most people would say: ‘I’ll take the five- to 10-minute plan, not the seven-day plan.’”

Ashe has been a family physician for almost 40 years. He offers palliative care in Brockville and is a member of the physicans’ advisory council at Dying With Dignity Canada. He says his support for assisted dying came as the result of many years of “watching people die, helping people to die and watching them suffer and coming to the realization that we can’t relieve all suffering.”

Since assisted dying legislation passed on June 17, Ashe has assisted in the deaths of four patients, and another patient has permission. “They’re content to know they have permission.”

When a patient dies, it’s a “sacred moment,” he says.

“None of us really want our patients to do this. We understand it. We honour their request and their autonomy. We would prefer to provide relief in another way. I have a contract with a patient. I am with you until you die. I am not going to send you off when things get tough.”

Physicians still feel ambivalent about helping patients die. At the Brockville General Hospital, where Ashe works, a survey of the medical staff found about three-quarters agreed or strongly agreed that people should have a right to assisted death, and almost two-thirds felt it should be offered at the hospital. But only 30 per cent pf physicians would be willing to provide assisted death — with proper training — while 43 per cent would not, with the remainder neutral. About three-quarters said they would refer patients, while 13 per cent said they would not refer. The remaining respondents were neutral.

Ashe believes that only a small subset of people will seek assisted dying. In Oregon, laws permit qualified terminally ill adults to request a prescription for a medication to hasten death. With a population of four million people, about 150 permissions for physician-assisted suicide are sought every year in Oregon. Interestingly, only two-thirds of those who request the prescriptiom actually take it.

“Knowledge is empowering. People won’t make that decision because it is available,” says Ashe. “They will choose it because that’s what they want.”

He was nervous at first about going public with his support for assisted dying. In December 2014, he spoke out after a terminal cancer patient in his care shot himself. This summer, he spoke about helping an ALS patient die at home. But feedback from family and colleagues has been gratifying, he says.

“To live through this era and see this come to fruition has been an amazing experience. That we can allow someone to die peacefully, painlessly, speaks volumes abut how far we have come as a society and as a profession.”

Ashe believes the current legislation doesn’t go far enough. He would like to see other patients have access, including people with severe mental illness and competent children. People with mental health problems suffer terribly and Ashe said he can see no reason why they shouldn’t qualify. People over the age of 18 qualify, but not those who are 17. That’s arbitrary, he argues.

“The beauty of dying where and when you want and with whom is pretty amazing,” he says. “One of the reasons why I have been advocating for this isn’t altruistic. I would like to live in a world where this is possible for myself.”

Complete Article HERE!

October 9, 2016October 6, 2016

More than 65 B.C. patients choose doctor-assisted death since June

by Jeff Nagel

So far 66 B.C. residents have ended their lives through physician-assisted death.

More than 65 B.C. residents have legally ended their lives with the help of a doctor since federal assisted death legislation took effect June 17.

Fraser Health officials confirm some of those deaths have been within this region, but referred requests for detailed numbers to the B.C. Coroners Service.

“Our first request was two days after the federal legislation was put in place,” said Lisa Zetes-Zanatta, Fraser Health’s executive director for palliative care, home care and residential care.

“A number of requests have come in and some have completed the service.”

Coroner Barb McLintock said it’s too soon to provide a regional or other breakdown on B.C.’s assisted deaths, which she said stood at 66 as of Wednesday.

The most high profile case so far made public has been that of author W.P. Kinsella, who lived in Yale and invoked Bill C-14’s assisted dying provisions Sept. 16 at Fraser Canyon Hospital.

The Catholic Church’s Vancouver Archbishop Mark Miller urged Fraser Health in an open letter not to mandate assisted dying as an option in palliative care wards, calling it a “cruel dilemma” for those vulnerable patients.

And Miller said it’s a “terrible conflict of interest” for palliative caregivers who may be compelled to offer “an economically expedient shortcut in the form of lethal injection” contrary to their ethical principles.

Zetes-Zanatta acknowledged that not all doctors or nurses are willing to participate, but said that has not been a barrier to finding sufficient volunteers.

“We’re very clear, as is the provincial and federal legislation, that conscientious objection is absolutely respected,” she said. “I would never force any of our staff into doing anything not consistent with their own moral, ethical or spiritual beliefs.”

Doctors can perform the assisted death injection independently if nursing staff who would normally assist are unwilling, she said.

Zetes-Zanatta noted the World Health Organization definition of palliative care is to protect and alleviate the suffering of patients until they reach a natural death.

“The number of palliative care physicians providing this service is less than other disciplines because it’s not aligned with their philosophy of care. That being said, there are palliative care physicians who are providing this service.”

More of the requests for assisted death come from people in the community than in hospices or palliative care settings, she added.

“We try to give the service where the patient is,” Zetes-Zanatta said. “They’re usually in intolerable suffering and so to move them is really difficult. We try to make this very much about the patient.”

Under the federal legislation, patients must be at end of life with death expected within the next six months to a year.

Only they – and specifically not youth or psychiatric patients – can make an initial request leading to more information on the assisted death option.

Usually those requests go through a family doctor, Zetes-Zanatta said, but Fraser Health will assign physicians to respond to patients who don’t have one.

“We ensure that they have had access to palliative care services and pain management services to see if we can alleviate their suffering prior to them making a formalized request for this.”

After the information provision stage, two doctors must conduct independent assessments, after which there is a 10-day waiting period before the patient can finally make the choice to die.

She said Fraser Health is now legally required to comply when patients qualify.

“Regardless of where people sit on this we have to recognize that there are patients requesting this. And we have to understand what that patient must be going through to put in a request like this.”

The legislation passed by the Justin Trudeau government came after the Supreme Court declared it unconstitutional to prevent suffering Canadians from getting medical assistance to hasten death.

Complete Article HERE!

October 8, 2016October 6, 2016

These Indonesians unearth their deceased loved ones every few years

Writer May-Ying Lam

People lift the coffin of Liling Saalino to a stone grave, or Liang, during a burial ritual, or Rambu Solo ceremony, in Lemo village, Toraja, South Sulawesi, Indonesia. During the procession, people chat “Tau Tae Sengke,” which means nobody should be angry.

It is said that Torajans are people who “live to die.”

For this Indonesian ethnic group, funerals are such extravagant events that they sometimes attract tourists. Families can postpone burials years (and the deceased are considered sick and hosted at home until the funeral) until the family can raise enough money and gather as many relatives as possible. And then it’s a jubilant multiday social event with a parade, dances and animal sacrifices.

Agung Parameswara photographed these funerary practices when he traveled to South Sulawesi province, where the Torajans live. But often, their funeral isn’t the last time the dead are seen.

In August, crypts are opened, coffins are slid back out and bodies delicately unsheathed. This tender ritual is known as Ma’Nene, which is customarily performed every few years. In this practice, which honors the Torajans’ ancestors, corpses are washed and dressed in new outfits. They may be treated to betel nuts and cigarettes, sometimes even taken back to the place where they died. And, finally, they are wrapped in new shrouds and replaced in their freshly repaired coffins.

Parameswara was moved when he saw the family of Yohanes Tampang bring him a new pair of sunglasses, which he loved to wear while he was alive. They touched his body and introduced him to new family members.

People carry the coffin of Liling Saalino as a part of the Rambu Solo ceremony. When a person dies, pigs, chickens and buffalo are sacrificed, as the locals believe that the animals carry the soul of the deceased into heaven. The number and type of animals killed reflect the social status of the dead person.

Villagers and relatives gather as they prepare for a parade during the Rambu Solo of V.T. Sarangullo in La’Bo village, Toraja, South Sulawesi, Indonesia. After the animals are killed, a feast is thrown and the body of the deceased placed in a stone grave, or Liang.

Men gather during a buffalo fight, or Tedong Silaga, as a part of the Rambu Solo for V.T. Sarangullo in La’Bo village, Toraja, South Sulawesi, Indonesia.

Men gather to perform a Ma’Badong dance during the Rambu Solo of V.T. Sarangullo.

Men remove a corpse from inside a Liang as they prepare to perform Ma’Nene in Pongko Village, Toraja, South Sulawesi, Indonesia. In Ma’Nene, bodies of the deceased are exhumed to be washed, groomed and dressed in new clothes. Damaged coffins are fixed or replaced.

A man holds the corpse of Tang Diasik, who died six years ago, as he dries the corpse during the Ma’Nene ritual in Ba’Tan village, Toraja, South Sulawesi, Indonesia.

A woman cries in front of the corpse of Marta Ratte Limbong during the Ma’Nene ritual in Ba’Tan Village, Toraja, South Sulawesi, Indonesia. Locals believe dead family members are still with them, even if they died hundreds of years ago.

Personal belongings of Marta Ratte Limbong inside the coffin including money, a necklace and two gold bracelets.

These practices are rooted in Aluk To Dolo, or the “way of the ancestors.” Though Torajans are predominately Christian, they still adhere to these ancient traditions.

Parameswara said via email that he felt that witnessing the rituals reminded him about how important connections with family are in a time when people can be self-absorbed. “Death is not a thing that could [separate] the Torajans people [from] their loved ones,” Parameswara said. “Love for the Torajans is eternal.”

Villagers pray before they perform the Ma’Nene ritual in Barrupu village, Toraja, South Sulawesi, Indonesia.

The Liang with Tau-Tau, or effigies made of wood in Lemo Toraja, South Sulawesi, Indonesia. These life-size representations of the dead were once produced only for the wealthy. They are guardians of the tombs and protectors of the living.

A boy lights incense in front of Lucas Payung’s body before the Ma’Nene ritual in Barrupu Village, Toraja, South Sulawesi.

Relatives cry as the coffin containing the bodies of Tikurara, Dumak and Limbongbuak arrived at the Liang in Barrupu village, Toraja. The corpses were buried in Makassar a few years ago; this year, the family decided to move the bodies to the stone grave in their hometown. But first, the family performed the Ma’Nene ritual.

Complete Article HERE!

October 7, 2016October 7, 2016

Archbishop Desmond Tutu ‘wants right to assisted death’

South Africa’s Archbishop Desmond Tutu has revealed that he wants to have the option of an assisted death.

The Nobel Peace Prize laureate and anti-apartheid campaigner said that he did “not wish to be kept alive at all costs”, writing in the Washington Post newspaper on his 85th birthday.

Mr Tutu came out in favour of assisted dying in 2014, without specifying if he personally wanted to have the choice.

He was hospitalised last month for surgery to treat recurring infections.

“I hope I am treated with compassion and allowed to pass on to the next phase of life’s journey in the manner of my choice,” Mr Tutu wrote.

“Regardless of what you might choose for yourself, why should you deny others the right to make this choice?

“For those suffering unbearably and coming to the end of their lives, merely knowing that an assisted death is open to them can provide immeasurable comfort.”

There is no specific legislation in South Africa governing assisted dying.

But in a landmark ruling in April 2015, a South African court granted a terminally ill man the right to die, prompting calls for a clarification of the laws in cases of assisted death.

Desmond Tutu and his wife have four children and seven grandchildren together

Born 1931
1970s: Became prominent as apartheid critic
1984: Awarded Nobel Peace Prize
1986: First black Archbishop of Cape Town
1995: Appointed head of Truth and Reconciliation Commission
Became a fierce critic of South Africa’s ANC
Supports assisted dying for the terminally ill

Complete Article HERE!

October 7, 2016October 6, 2016

My patient ended her life at Dignitas to avoid a slow, undignified death

Her courage showed me assisted dying should be legal in the UK so the terminally ill can have some control

By Anonymous

dignitas — I gained great insight into the courage and tenacity it takes to go to Dignitas.

Some years ago, while working as a district nurse at a GP practice, one of the receptionists came to tell me she had just taken a phone call from the son of a patient to say he had returned from the Dignitas clinic in Switzerland. His mother, who had recently been diagnosed with a neurological condition that would kill her slowly, and with loss of dignity and independence, had taken her life there.

The reception staff were shocked. I was shocked. My team was shocked. I was dismayed that this lady, who I had known for a number of years, had to go to another country to receive the care she wanted and to die earlier than she should have.

The following day her GP asked me what Lily* had been up to over the past few days. You can tell from this perhaps that Lily was a lady who made demands on the surgery team. The GP was upset when I told her what had happened, and contacted Lily’s son.

I had known this lady for a number of years and looked after her husband when he returned from hospital after surgery. Lily would turn up at the surgery immaculately dressed and would not leave until she obtained what she thought would help him. I would sometimes receive a phone call from the surgery asking me to come back from my house calls to see her. I was not the only person at the surgery with whom she could be quite insistent. Yet even as she frustrated us all, I found it noble the way she fought for what she thought was best for her husband.

After he died I saw her only occasionally. A few years later her health deterioriated and I became involved in her care. Occasionally I found it frustrating when, in the middle of a clinic or housecall, I would be contacted to say Lily wanted to see or speak to me. Many a day on my way home I would have to call into her house to reassure her or deal with a problem.

After her diagnosis she was matter of fact as we discussed plans for her care and how to deal with her condition. She was living on her own and had no intention of “burdening” her children. Despite the fact that she could be difficult, I found her likeable with a very dry sense of humour and fun.

I found out later that before she died she had bought a new outfit to travel in, and been to a favourite view she and her husband used to visit and to a favourite restaurant.

The point of telling this story is that I gained great insight into the courage and tenacity it takes to go to Dignitas and that there should be a way of assisting someone who is of firm mind to take their own life in these circumstances. Perhaps if she had felt she would have had control of the situation in this country Lily would not have found it necessary to take her own life at all; certainly she would have had a longer life. I feel privileged to have known a very brave woman, even if she could drive me to distraction.

Complete Article HERE!

October 6, 2016October 5, 2016

Let Me Die My Way

As a D.C. Council committee prepares to vote today on a death with dignity bill, a terminal patient urges passage.

By Mary Klein

I do not know how long I have to live. I have aggressive ovarian cancer that has spread throughout my body. I want to live, and I’m doing everything possible to continue living, including surgery that took 42 industrial strength staples to stitch me back together and chemotherapy that has life-threatening side effects and has caused nerve damage, which limits my ability to walk.

Despite these efforts, my cancer cannot be cured. It is terminal. Intolerable, constant pain is a real possibility I must confront.

When I have only a few months left to live, I would like the option to obtain medication that I alone could decide to take to peacefully leave this world. I might decide not to take it, but it would bring me great comfort to know that it is available.

The “Death with Dignity Act” would provide this option to me.

The D.C. Council’s Health and Human Services Committee is scheduled to vote today on whether to approve this legislation for consideration by the full D.C. Council.

Some people fear that the bill would lead to abuses, but those fears have proved unfounded. Oregon and four other states with medical-aid-in-dying options, have not found any incidents of abuse.

The legislation only provides the option to a terminally ill person who has six months or less to live, who personally requests the medication from two doctors and is found to be of sound mind and is acting independently. The patient must take the medication herself, but is under no obligation to take it.

The qualification requirements in the bill, which is modeled after Oregon’s nearly 20-year-old death-with-dignity law, include verification of the patient’s diagnosis and mental competency by two physicians.

A terminally ill person should not have to endure needless suffering in her or his final days. I ask that my choice to have a peaceful death be respected in the same way as other medical decisions made privately with one’s doctor.

I urge the D.C. Health and Human Services Committee and the full Council to approve the Death with Dignity Act and Mayor Muriel Bowser to sign it into law, so terminally ill DC residents like me do not have to worry about dying in agony.

Complete Article HERE!