All pets go to heaven.

— She helps them do it at home.

Eden Gaines, left, talks with veterinarian Karen Meyers about the decision to euthanize Xochitl, a boxer-Great Dane mix who has cancer.

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Veterinarian Karen Meyers pulls her black minivan into the driveway of a townhouse in Maryland’s National Harbor. The home, in a gated community, is perched on a windy bluff not far from restaurants, bars, a casino — places of revelry.

The vet carries her brown doctor’s bag inside. There, she meets her patient: Xochitl, known as Xochi, an 11-year-old boxer-Great Dane mix weighing around 80 pounds.

Xochi, recently diagnosed with cancer, is struggling. A film covers her right eye. She had been bleeding from her mouth, refusing to eat. Now she stands in the townhouse’s living room, mournfully greeting family members who have come to say goodbye.

Xochi climbs onto the living room’s leather couch and lies down. Owner Eden Gaines and her family gather around her. Meyers opens her bag.

Meyers explains the procedure. First, Xochi will be injected with a sedative to make her fall asleep. Five to 10 minutes later, Meyers will administer sodium pentobarbital, which will euthanize her. But Xochi would feel no pain, Meyers assures the family.

She asks whether anyone has any questions.

No one does.

“Here we go,” she says.

Meyers says she has euthanized 1,500 animals in four years.

Pet adoption spiked during the pandemic, with nearly 1 in 5 American households taking animals in and spending far more on them than pet owners did decades ago. With more beasts in our lives — as companions, as emotional support animals, as the beneficiaries of pet trusts — it only makes sense that their owners want their final moments in their lives to be as peaceful and painless as possible.

That’s where Meyers comes in. Working with Lap of Love, a company that provides veterinarian referrals for at-home pet euthanasia, she travels from house to house in the D.C. region offering grieving families’ animals what the word euthanasia means: “good death.” In four years, she has euthanized 1,500 animals: cats, dogs, rabbits, rats. Some had been with their owners since childhood. Some had traveled the world with them. Some were their owner’s sole companion.

Meyers has observed death rituals that include praying, burning incense, wrapping a deceased pet’s body in a white sheet, and opening a window for a pet’s spirit to exit. She has listened to owners read poems or letters to their pets and cried along with them.

“When people hear what I do for living, it sounds sad,” Meyers says. “But it’s strangely rewarding. … You give pets a peaceful experience. It’s a final gift.”< Meyers has been surrounded by a menagerie all her life. Growing up, she usually had a dog and one or two cats; at various times, she’s also had two hamsters, two turtles, a guinea pig, a bird and four chickens. Right now, she has Wren, a 6-year-old Cavalier King Charles spaniel; Travis, a 3-year-old pug; Brinkley, a 13-year-old rat terrier Chihuahua; and Pablo, a red-belly parrot. Right before the pandemic, Meyers decided to shift to doing euthanasia full time. She had been a veterinarian for more than two decades, and pet euthanasia turned out to be less stressful than working in an office while raising two children. In-home euthanasia can be easier on animals and their owners than office appointments with other sick animals and their distressed owners crowded around.

The first injection makes Xochi fall asleep.
Rameses Gaines holds a piece of Xochi’s fur.

Meyers administers the first shot in Xochi’s back. The dog, already lying down with her head on Gaines’s lap, turns to glance at Meyers as if mildly annoyed.

Then, the dog relaxes.

Minutes pass.

Using a hair clipper, Meyers shaves an inch-long strip of one of Xochi’s legs and inserts a small IV line. After confirming that the family wants to continue, Meyers administers the second shot, the one with the fatal dose.

Gaines looks at the spot on Xochi’s leg where the IV had been inserted.

“It’s amazing how gray she became,” Gaines says.

Meyers holds a stethoscope to Xochi’s chest. “Xochi has her wings,” she says.

The family cries.

So does Meyers.

She and Gaines embrace.

Meyers maneuvers Xochi onto a stretcher and covers her with a blanket. With the help of Gaines’s sons, she loads the dog into her car. Eventually Xochi will be cremated and her ashes returned to the Gaines family.

Death is a part of life, Meyers says.

“Many times, people will comment how a human family member passed, and it was so painful at the end, and this is peaceful by contrast,” she says.

They tell her, she says, that they wish they could go the same way.

Rameses Gaines touches a mold of Xochi’s paw print.

Complete Article HERE!

I Asked My Mom if She Was Prepared to Die

— Then I talked to some end-of-life experts. Here’s what I found out.

By By Shaina Feinberg and Julia Rothman

Recently, I had the following conversation with my 82-year-old mother, Mary:

Me: Are you prepared to die?

My mom: Not really. But I am prepared with my paperwork.

You might be wondering why I was asking my mom about her end-of-life preparedness. Well, when my dad, Paul, died suddenly a few years ago, we were completely unprepared.

“Dad and I never talked about what he wanted for his funeral,” my mom said. “He was 74 when he died, and he was in pretty good shape.”

On top of everything she had to do when he died, like planning the funeral, there was also the stress of finances and paperwork. “We had a joint checking account, but it didn’t have a lot of money. Our other bank account had more money, but was only in his name. I had to get that sorted out, which took ages.”

The most helpful advice my mom got when my dad died? “My best friend, Fran, told me, ‘Get a lot of death certificates because you’re going to have to send them to people and sometimes they don’t want a Xerox, they want the real thing.’ I got 15 death certificates from the funeral parlor.”

Preparing to die is complicated. How’s that for an understatement? You have to consider the emotional, spiritual and financial aspects. We talked to three end-of-life experts who unpacked how to make this extensive undertaking slightly more manageable.

According to a survey by Ethos, fewer than half of Americans have discussed their end-of-life plans with loved ones. Yet having these conversations is important, said Sarah Chavez, executive director of the nonprofit the Order of the Good Death, which provides resources to learn about and plan for death.

“These talks can be awkward,” Ms. Chavez said, “but by planning and talking about these things, it’s such a gift for the family that’s left behind.”

While you’re thinking about what to do with your body, you’ll also want to consider what to do with your stuff. “At a baseline, everybody should have a couple documents that are in effect while you’re alive,” said Michael Pevney, an estate planning lawyer with a practice in California. (He also makes videos about estate planning on TikTok.)

No matter what you decide to do with your body or your stuff, you will need someone to carry out your requests.

If you’re unwilling to ask your loved ones about their death preparations, there are other ways to broach the subject. “The easiest way is to open the family photo album and start having conversations about the people in the pictures,” said Joél Simone Maldonado, a funeral director and death educator. “The conversation always turns to what people did or didn’t like about a funeral or grieving process.” Mrs. Maldonado suggests using those conversations as a springboard to ask questions about what people’s end-of-life hopes are. And take notes.

The only upside to being so unprepared for my dad’s death is that now my mom is super prepared. “I have several folders in a cabinet that have all the things you should do when I die,” she said. “I’ve listed you as power of attorney, so you can write a check for the funeral. I’ve paid for my gravesite already. I’ll be next to Dad, under the same gravestone.”

When I asked my mom how she feels looking at the empty side of the gravestone, she said: “There’s my side. I have a place! Oh, and remember,” she added, “I’ve always wanted a mariachi band at my funeral.” Noted.


Complete Article HERE!

Overdose or Poisoning?

— A New Debate Over What to Call a Drug Death.

Sandra Bagwell of Mission, Texas, holding the remains of her son, Ryan, who died in 2022. “Ryan was poisoned,” she said.

Grieving families want official records and popular discourse to move away from reflexive use of “overdose,” which they believe blames victims for their deaths.

By Jan Hoffman

The death certificate for Ryan Bagwell, a 19-year-old from Mission, Texas, states that he died from a fentanyl overdose.

His mother, Sandra Bagwell, says that is wrong.

On an April night in 2022, he swallowed one pill from a bottle of Percocet, a prescription painkiller that he and a friend bought earlier that day at a Mexican pharmacy just over the border. The next morning, his mother found him dead in his bedroom.

A federal law enforcement lab found that none of the pills from the bottle tested positive for Percocet. But they all tested positive for lethal quantities of fentanyl.

“Ryan was poisoned,” Mrs. Bagwell, an elementary-school reading specialist, said.

As millions of fentanyl-tainted pills inundate the United States masquerading as common medications, grief-scarred families have been pressing for a change in the language used to describe drug deaths. They want public health leaders, prosecutors and politicians to use “poisoning” instead of “overdose.” In their view, “overdose” suggests that their loved ones were addicted and responsible for their own deaths, whereas “poisoning” shows they were victims.

“If I tell someone that my child overdosed, they assume he was a junkie strung out on drugs,” said Stefanie Turner, a co-founder of Texas Against Fentanyl, a nonprofit organization that successfully lobbied Gov. Greg Abbott to authorize statewide awareness campaigns about so-called fentanyl poisoning.

“If I tell you my child was poisoned by fentanyl, you’re like, ‘What happened?’” she continued. “It keeps the door open. But ‘overdose’ is a closed door.”

For decades, “overdose” has been used by federal, state and local health and law enforcement agencies to record drug fatalities. It has permeated the vocabulary of news reports and even popular culture. But over the last two years, family groups have challenged its reflexive use.

They are having some success. In September, Texas began requiring death certificates to say “poisoning” or “toxicity” rather than “overdose” if fentanyl was the leading cause. Legislation has been introduced in Ohio and Illinois for a similar change. A proposed Tennessee bill says that if fentanyl is implicated in a death, the cause “must be listed as accidental fentanyl poisoning,” not overdose.

Meetings with family groups helped persuade Anne Milgram, the administrator of the Drug Enforcement Administration, which seized more than 78 million fake pills in 2023, to routinely use “fentanyl poisoning” in interviews and at congressional hearings.

Various snapshots of Mrs. Bagwell’s son, Ryan, on a cork board.
Ryan died after swallowing one pill from a bottle of what he believed to be Percocet, a prescription painkiller.
A dog sits on a chair on a patio, seeming to look through the window at a framed portrait of Ryan Bagwell that rests on a table.
Ryan Bagwell left behind his dog, Macy.

In a hearing last spring, Representative Mike Garcia, Republican of California, commended Ms. Milgram’s word choice, saying, “You’ve done an excellent job of calling these ‘poisonings.’ These are not overdoses. The victims don’t know they’re taking fentanyl in many cases. They think they’re taking Xanax, Vicodin, OxyContin.”

Last year, efforts to describe fentanyl-related deaths as poisonings began emerging in bills and resolutions in several states, including Louisiana, New Jersey, Ohio, Texas and Virginia, according to the National Conference on State Legislatures. Typically, these bills establish “Fentanyl Poisoning Awareness” weeks or months as public education initiatives.

“Language is really important because it shapes policy and other responses,” said Leo Beletsky, an expert on drug policy enforcement at Northeastern University School of Law. In the increasingly politicized realm of public health, word choice has become imbued with ever greater messaging power. During the pandemic, for example, the label “anti-vaxxer” fell into disrepute and was replaced by the more inclusive “vaccine-hesitant.”

Addiction is an area undergoing convulsive language change, and words like “alcoholic” and “addict” are now often seen as reductive and stigmatizing. Research shows that terms like “substance abuser” can even influence the behavior of doctors and other health care workers toward patients.

The word “poison” has emotional force, carrying reverberations from the Bible and classic fairy tales. “‘Poisoning’ feeds into that victim-villain narrative that some people are looking for,” said Sheila P. Vakharia, a senior researcher at the Drug Policy Alliance, an advocacy group.

But while “poisoning” offers many families a buffer from stigma, others whose loved ones died from taking illegal street drugs find it problematic. Using “poisoning” to distinguish certain deaths while letting others be labeled “overdose” creates a judgmental hierarchy of drug-related fatalities, they say.

A portrait of Fay Martin, who wears a gray, long-sleeved sweater and leans on a fence overlooking a canal with boats docked in it.
Fay Martin of Corpus Christi, Texas. Her son Ryan died in 2021. “When my son died, I felt that stigma from people, that there was personal responsibility involved because he had been using illicit drugs,” she said.

Fay Martin said her son, Ryan, a commercial electrician, was prescribed opioid painkillers for a work injury. When he grew dependent on them, a doctor cut off his prescription. Ryan turned to heroin. Eventually, he went into treatment and stayed sober for a time. But, ashamed of his history of addiction, he kept to himself and gradually began to use drugs again. Believing that he was buying Xanax, he died from taking a fentanyl-tainted pill in 2021, the day after his 29th birthday.

Although he, like thousands of victims, died from a counterfeit pill, his mourning mother feels as if others look at her askance.

“When my son died, I felt that stigma from people, that there was personal responsibility involved because he had been using illicit drugs,” said Ms. Martin, from Corpus Christi, Texas. “But he didn’t get what he bargained for. He didn’t ask for the amount of fentanyl that was in his system. He wasn’t trying to die. He was trying to get high.”

To a growing number of prosecutors, if someone was poisoned by fentanyl, then the person who sold the drug was a poisoner — someone who knew or should have known that fentanyl could be lethal. More states are passing fentanyl homicide laws.

Some people note that the idea of a poisoner-villain doesn’t account for the complications of drug use. “That’s a little too simplified, because a lot of people who sell substances or share them with friends are also in the throes of a substance use disorder,” said Rachael Cooper, who directs an anti-stigma initiative at Shatterproof, an advocacy group.

People who sell or share drugs are usually many steps removed from those who mixed the batches. They would likely be unaware that their drugs contained deadly quantities of fentanyl, she said.

“In a nonpoliticized world, ‘poisoning’ would be accurate, but the way it’s being used now, it is reframing what is likely an accidental event and reimagines it as an intentional crime,” said Mr. Beletsky, who directs Northeastern’s Changing the Narrative project, which examines addiction stigma.

In toxicology and medicine, “overdose” and “poison” have value-neutral definitions, said Kaitlyn Brown, the clinical managing director of America’s Poison Centers, which represents and collects data from 55 centers nationwide.

“But the public is going to understand terminology differently than people who are immersed in the field, so I think there are important distinctions and nuances that the public can miss,” she said.

“Overdose” describes a greater dose of a substance than was considered safe, Dr. Brown explained. The effect may be harmful (heroin) or not (ibuprofen).

“Poisoning” means that harm indeed occurred. But it can be a poisoning from countless substances, including lead, alcohol and food, as well as fentanyl.

Both terms are used whether an event results in survival or death.

Photos of Ryan Paul Malcolm arrayed on a kitchen table in Fay Martin’s home.
Ryan Paul Malcolm went into treatment for addiction, but when he started using again, he kept to himself. Believing he was buying Xanax, he died from fentanyl in a tainted pill in 2021.
A shiny orb on a stand, a special urn containing Ryan’s ashes, sits on a bureau in a bedroom under a television.
Ryan’s urn in Ms. Martin’s home. He was an avid Denver Broncos fan.

Until about 15 years ago, the Centers for Disease Control and Prevention, an esteemed source of data on national drug deaths, often used both terms interchangeably. A C.D.C. report detailing rising drug-related deaths in 2006 was titled “Unintentional Drug Poisoning in the United States.” It also referred to “unintentional drug overdose deaths.”

To streamline the growing drug fatality data from federal and state agencies, the C.D.C. shifted exclusively to “overdose.” (It now also collects statistics on reported nonfatal overdoses.) The C.D.C.’s Division of Overdose Prevention notes that “overdose” refers just to drugs, while “poisoning” refers to other substances, such as cleaning products.

When asked what unbiased word or phrase might best characterize drug deaths, experts in drug policy and treatment struggled.

Some preferred “overdose,” because it is entrenched in data reporting. Others use “accidental overdose” to underscore lack of intention. (Most overdoses are, in fact, accidental.) News outlets occasionally use both, reporting that a drug overdose took place due to fentanyl poisoning.

Addiction medicine experts note that because most of the street drug supply is now adulterated, “poisoning” is, indeed, the most straightforward, accurate term. Patients who buy cocaine and methamphetamine die because of fentanyl in the product, they note. Those addicted to fentanyl succumb from bags that have more toxic mixtures than they had anticipated.

Ms. Martin, whose son was killed by fentanyl, bitterly agrees. “He was poisoned,” she said. “He got the death penalty and his family got a life sentence.”

Complete Article HERE!

Is extending life by weeks worth the toll some cancer drugs take?

— Doctors push for ‘common-sense oncology’

When a treatment buys a few weeks or months but comes with with a lot of side-effects, then the perspectives of people with cancer may differ, says Dr. Christopher Booth.

People may celebrate a 2-week improvement in survival without acknowledging costs

By Amina Zafar, Christine Birak

Tom Somerville’s decision to stop medical treatment for his end-stage cancer was a personal one.

Somerville, 62, was diagnosed with colon cancer in 2021 that later spread to his liver. He had six months of chemotherapy to slow down the cancer, which he said also left him exhausted with nausea.

The Kingston, Ont., resident decided to take a break from treatment to enjoy a trip with his wife to Victoria.

“Things that you cherish change, right?” Somerville said. “I used to love being out in the bush, but now it is just nice to have a sunny day, sit with my family [and] have visitors.”

Somerville said he came to terms with his prognosis and decided to enjoy the rest of the life he has left, extending the chemo break to a full stop. He said he was relieved to not “feel crappy” from the treatment anymore.

A man stands with a woman holding an umbrella while on vacation in B.C.
Tom Somerville, left, and his wife, Katherine Somerville, enjoyed a vacation in Victoria while he paused cancer treatments.

Dr. Christopher Booth, Somerville’s medical oncologist at Kingston General Hospital, supports him in his decision.

Booth is also part of a group of cancer doctors in Canada and the U.S. who say medications with marginal benefits are overused for patients in the end stage of the disease. The oncologists have started a campaign through their website, journal articles and podcasts encouraging honest conversations about use of the drugs with cancer patients, their families and experts.

The goal of what they call “common-sense oncology” is to prioritize treatments that meaningfully improve survival and quality of life. They aim to address what they see as problems in the field, such as a lack of critical thinking in oncology training, falling standards for drug approvals and avoidance of end-of-life discussions.

Balancing hope and reality

Booth said while there have been incredible advances in cancer treatments in his 20 years of practice, there’s also an unfortunate reality: cancer can’t always be cured. He strives to convey it in a compassionate and clear way.

“Balancing … providing information but also providing hope, that’s the art of cancer care,” Booth said. “Balancing hope and reality, balancing treatment and quality of life and side-effects, that’s the tough part of this job.”

Booth said he thinks everyone would agree that a treatment that helps a patient live for extra months or years is very helpful. But when a treatment buys weeks with a lot of side-effects, then patient perspectives may differ.

In part that’s because the cancer drugs that can shrink tumours alsocome with side-effects, including fatigue, vomiting and hair loss.

A woman with long hair, seated wearing a black top and black glasses.
Not having treatment for cancer isn’t giving up, says Rachel Koven of Kingston, Ont.

Dr. Bishal Gyawali, a medical oncologist and associate professor at Queen’s University in Kingston, was motivated to press for changes when he noticed increased spending on treatments that don’t make much difference in patients’ lives while at the same time agencies didn’t put resources to what’s already been proven to work.

Gyawali previously treated people with cancer in Nepal, Japan, and the U.S. and saw the same trends there.

When attending oncology conferences, Gyawali said presenters would celebrate a two-week improvement in survival from a new treatment. Then, behind closed doors, other delegates would talk about the risks and costs of the drug.

“People are saying is this really meaningful?”

Gyawali aims to normalize asking such questions.

Quality of life and quantity

Rachel Koven’s husband, Ken Koven, was diagnosed in his late 40s with adenocarcinoma, which starts in gland cells of the esophagus tube. His cancer was found where the esophagus meets the stomach.

The father and avid runner treated having cancer like a battle, his wife said. He had nine months of palliative chemotherapy that’s given to relieve the symptoms of cancer and improve quality of life, but not meant to cure the malignancy.

The cancer spread. He then underwent radiation to the brain in Kingston, Ont. In 2016, about 16 months after the diagnosis, he died at age 49.

“For my husband, his hope was anchored in treatment,” Koven said. “However well-rounded the discussions we had, he would have always chosen treatment, and I can’t begrudge him for that because that is where he believed his strength was.”

Now, Koven feels families should ask more questions of doctors, such as:

  • How much time does this treatment offer?
  • What are the real costs and benefits of the treatment?

Koven said not having treatment is sometimes seen as throwing in the towel, but that can be misleading.

A man stands wearing glasses, a striped shirt, suit jacket and conference lanyard in front of a blue backdrop reading American Society of Clinical Oncology.
Dr. Bishal Gyawali wants people to ask whether a two-week improvement in survival is meaningful.

“Not having treatment isn’t giving up,” Koven said. “Sometimes by having treatment you are giving up. You are giving up time with your family. You are giving up a quality of life necessarily for something you are not trading off any extra days.”

Koven wrote an essay in 2018 on her experience as her husband’s caregiver in the Canadian Medical Association Journal. At the time, she was motivated “to contribute to the best possible life in the face of death.”

Now Koven advocates for the oncology field to “recalibrate” toward an emphasis on what brings the person joy rather than only focusing on treating their cancer. Finding novel treatments that will really benefit patients is also important to her.

Seek meaningful answers

Dr. Elizabeth Eisenhauer ran more than 170 cancer drug trials in Canada, the U.S. and Europe. Now retired, Eisenhauer won the 2021 Canada Gairdner Wightman Award for investigating new cancer drugs and delivery approaches, including for Taxol, an anti-cancer treatment.

“It’s a good thing we are having so much interest in finding novel therapeutics for cancer,” Eisenhauer said. “But my goodness, let’s find the answers that matter to patients, too.”

Eisenhauer recalled how in the 1980s, scientists set an arbitrary number as a standard, worldwide indicator of safe tumour shrinkage for early clinical trial research.

After that, measuring whether a tumour grew by 20 per cent on a CT scan, the definition of progression, became an endpoint, or goal, for pharmaceutical companies running randomized trials, Eisenhauer said. Randomized trials are meant to guide whether a drug should be used as a standard of care by physicians.

“You have an answer sooner [using tumour shrinkage], but is it an answer that is meaningful?” she said.

Eisenhauer would like to see cancer clinical trials include more criteria.

“I think common-sense oncology from my perspective as a trialist needs to come from the perspective of trying to be sure that the trials that we design at least can capture the information that will be of importance to those discussions with the patient sitting in front of you.”

Eisenhauer said there aren’t a huge number of game changers in oncology every year, but many are available in Canada. She said costs to patients in terms of side-effects and time coming to the clinic also need to be considered.

A patient receives chemotherapy treatment for breast cancer in France.
Randomized trials are meant to guide whether a physician should use a chemotherapy agent as a standard of care.

Despite that, other Canadian researchers looking last year at use of treatments like chemotherapy or major surgery among more than 151,000 people who died found that a treatment was commonly given — in 41 per cent of cases — in the last 30 days of life but was potentially inappropriate.

So far, Gyawali said the common-sense oncology movement is gaining momentum worldwide and he’s received positive feedback from regulators, physicians, patients and payers.

Tom and Katherine Somerville now take time every day to enjoy moments together, like walking down to the pond near their farmhouse, going for a drive on a sunny day or listening to old tunes.

For them, quality of life includes loving glances.

“You appreciate that moment and you want to take it all in and those are the simple things that really are not so simple,” Katherine said. “They’re the important things.”

How to Make End-of-Life Planning Less Stressful

— One tip: Do it over chocolate cake.

By Jancee Dunn

I recently hosted a strange family gathering: an end-of-life lunch.

It was my sister Dinah’s idea. She had been saying for months that it was time to discuss my parents’ final wishes while they were both still able to weigh in.

But I kept putting off the conversation. Who wants to think about it, whether it’s your own or the death of someone you care about?

Research shows that fewer than one third of U.S. residents have advanced-care directives, or detailed medical instructions in the event they can’t communicate their own wishes. Without such instructions, loved ones are left to use guesswork, which can be confusing and chaotic.

So I pushed past my reluctance and invited the family over to talk about everything from their positions on resuscitation and funeral plans to who will take their cats. I even tried to make things festive by ordering pizza and baking a chocolate cake.

I learned things about my family that I never knew: My mom and dad don’t want a memorial service. (“We don’t like big gatherings, whether we’re alive or dead,” my mom explained.) My sister Heather, meanwhile, wants hers to be held at Starbucks. (A Starbucks rep said that while this was “definitely a unique inquiry that we don’t get across our desks often,” they declined to comment further.)

Our lunch was occasionally weird — my dad once read that your “cremains” can be pressed into a working vinyl record, and he briefly floated the idea — but the gathering wasn’t as sad or awkward as I imagined it would be. Instead, it was a relief to chat openly about my folks’ end-of-life wishes instead of repeatedly stashing them away.

If you’ve been putting off these discussions, here’s how to get started.

Schedule a conversation.

First, ask your relatives if they’d be open to a family meeting — in person or on Zoom — and then set a date.

If you need a conversational starter, Mirnova Ceide, an associate professor of geriatric psychiatry and geriatrics at Albert Einstein College of Medicine, suggested bringing up a news story about dementia. “You can say, ‘This got me thinking about how important it is for us to talk about these issues now,’” she said.

If you are the older relative, consider initiating the family meeting yourself, Alua Arthur, an end-of-life doula and the author of the upcoming book “Briefly Perfectly Human,” suggested.

It might feel uncomfortable to broach the subject, she explained, but you can think of getting your affairs in order as a posthumous gift to your family.

You are sparing them a scenario “where they are in the midst of tremendous grief, and then they’re also trying to figure out what to do with all your stuff and where to find your passwords and everything else,” Arthur said.

Prepare a checklist.

Create a document that the whole family can access, and assemble a checklist of topics and prompts to go over, Dr. Ceide said. A good source for questions, she said, is the end-of-life guidelines from the National Institute on Aging.

The two vital things to discuss in the initial meeting, Dr. Ceide said, are who will serve as a health care proxy, acting as your stand-in for health care decisions, and what directives should be in your living will.

“We cannot exert control over the timing and nature of our death,” Diane Meier, a professor of geriatrics and palliative medicine at the Icahn School of Medicine at Mount Sinai, added. “You cannot anticipate exactly what the circumstances will be. So the most important thing to do is to identify someone you trust to speak for you if you are unable to speak for yourself when decisions need to be made.”

The institute also has a list of ways to create advance directives for little or no cost. (And Medicare covers advance care planning as part of your yearly wellness visit.)

Once you decide on your health care proxy and draft a living will, you can make it official by completing a durable power of attorney for health care, a legal document that names your health care proxy. Then distribute copies to your doctor, loved ones and, if you have one, a lawyer. (A lawyer is helpful but not required, according to the institute.)

Get reflective.

Our family had a long talk about how my parents wanted to spend their remaining years. Arthur, the doula, suggested asking: What is still undone in your life? “Because that helps you figure out where you want to place your time and energy,” she said.

We went over the things our parents still wanted to do, and how we could make them happen. My parents said they hoped to travel locally a bit more. My dad wants to attend his 65th high school reunion in Michigan (“at my age, they do it every five years”). Dinah, my sister, said she would accompany him.

Another helpful resource is the Stanford Letter Project, a free website that offers tools and templates for writing a “last letter,” a personal message of gratitude, forgiveness or regret to share with the people you love.

Consider regular check-ins.

End-of-life care is likely too big a topic to resolve in one meeting, Dr. Ceide said. She encourages families to have a regular conference call to check in.

Doing this can help you get on the same page so you’re all aware of, and planning for, issues like getting a ramp for your parents’ house, Dr. Ceide explained. You’re able to address “little things as they come so that when the bigger issues happen, you already have an infrastructure and a comfort with communicating together about these things.”

After our meeting, my father asked me to pack up a piece of chocolate cake to take home. “After all this death talk, I should probably seize the day,” he said.

Complete Article HERE!

Death doulas

— Helping people at the end of their life

By

You may have heard of a birth doula – someone who provides non-medical support and advocacy throughout pregnancy, birth and after the baby has been born. More recently, so-called death doulas – people who assist at the other end of the lifespan – have been growing in popularity.

The role of death doulas is still relatively new, so the terminology and definitions of what they are based on what they do are in flux. They are sometimes referred to as an end-of-life doula, soul midwife, death coach, dying guide, death midwife and palliative care doula. The actual term used is often down to the preference of the practitioner and how they define their work, as well as cultural norms within the country they work in.

Death doulas are known to work in Brazil, Canada, the Czech Republic, Germany, Ireland, Italy, Japan, New Zealand, Russia, the UK and the US. They tend to provide support to people with life-limiting or terminal illnesses, focusing on improving both the quality of life and the quality of death someone experiences. This can include helping with funeral plans, talking about the processes involved around death, or helping someone with their care appointments.

Sometimes, the doula’s contribution is simply about being next to the person and providing company.

The work of a death doula can extend beyond the dying person. They can provide emotional and social support to family, friends and even neighbours – typically the informal carers and social network surrounding the dying person.

Doulas help those close to the dying person with the impending loss (so-called anticipatory grief). Some also carry out errands and chores to enable them to spend time with the dying person. They may also continue to visit those people after the death to support them as they grieve. Crucially, death doulas can enhance the links between professionals and the social support around a person by helping with communications and advocacy work.

Filling the gap

With healthcare systems and informal carers typically stretched beyond capacity, death doulas can provide a means to fill the gap and provide personalised attention. Someone can access doula support either privately or, depending on the doula, through voluntary means.

My colleagues and I recently examined how end-of-life doulas can be provided by the NHS. It noted that the flexibility of the services doulas can provide was not only helpful for the dying person but also for the wider healthcare system. It helped people who may otherwise not receive support due to service gaps, strict referral criteria, or lack of social support.

Beyond supporting individuals, some death doulas see community engagement as core to their role. They are keen to share information about the dying process and grief with others. They may host workshops or death cafes. Across this work, their contributions are to normalise talking about death, dying and loss in society.

Anyone can become a death doula, and it is not currently a regulated profession. There is a wide range of doula training available internationally, including online, provided either by individual doulas or by organisations such as Living Well Dying Well.

People at a death cafe
Death cafes give people the space to talk about the ultimate taboo.

Personal experience

In addition to their doula training, doulas bring their own professional and personal experience to the role. International research on death doulas has noted that many who have become death doulas have a background in professional healthcare, social care or education, and may already have some experience with death.

Those who have trained to be a death doula can be eligible to join a community of practice. Within the UK, End of Life Doula UK is a membership organisation for doulas, setting standards for doula practice and representing doulas. Similar organisations exist globally, including the International End of Life Doula Association.

Death doulas are not a replacement for specialist palliative care and cannot prescribe drugs. Their role is to support people in having a good death.

The growing demand for death doulas is one example of how society is questioning what a good death can be and how to make it happen. Other examples include discussions about assisted dying and improving death literacy. Rather than consider death a societal taboo, there is a growing recognition that people want to value the end of life and reshape how it is experienced.

Death doulas can play a pivotal role in supporting a dying person and those around them. Their support can be emotional and practical, often bridging the gaps in existing support or helping to signpost to relevant services. Not everyone may want a doula, but those who do may see it as someone who can guide them through a significant life process.

Complete Article HERE!

Planning for end-of-life expenses amid soaring costs

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

The unavoidable cost of dying

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

Deepening funeral costs

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

The true ‘killer:’ Medical care costs

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

Planning for estate and legal considerations

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

Strategic planning for end-of-life expenses

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

    The role of agents and advisors

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

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

    Complete Article HERE!