Tag: Education

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Death Has Many Names

Not a day goes by that speakers of the Yoruba language do not make mention of death as both a phenomenon and a certainty.

Jacob Kehinde Olupona

By George Yancy

This month’s conversation in our series exploring religion and death is with Jacob Kehinde Olupona, a professor of African religious traditions at Harvard Divinity School. He is the author of “City of 201 Gods: Ilé-Ifè in Time, Space, and the Imagination” and “African Religions: A Very Short Introduction.” In this discussion we focused on the religious tradition of the Yoruba people. Previous interviews in this series — with scholars from the Buddhist, Christian, Jewish, Muslim, Jain, Taoist and atheist traditions — can be found here. — George Yancy

George Yancy: Here in the West, where a few monotheistic religions dominate the culture, knowledge and understanding of Indigenous African religious practices is rare. Is Yoruba monotheistic or polytheistic? Or is it something else entirely?

Jacob Kehinde Olupona: Yoruba religion manifests elements of both. It differs from many world religions that define their cosmology primarily in theistic terms. Yoruba religion focuses on the lived religious experience of the people rather than on systematized beliefs and creeds as we see in other world religions such as Islam and Christianity. Yoruba religious traditions are woven around oral traditions and practices. The spiritual realm exists parallel to the human realm and it accommodates the Supreme Being, gods, ancestors and minor spiritual entities who interact with the human realm at different levels.

Central to the Yoruba religious worldview is the notion of (Ase), which Rowland Abiodun has characterized as “the empowered word that must come to pass,” “life force” and “energy” that regulates all movement and activity in the universe. Religious activities are mostly communal and are guided by specialists, custodians and leaders of the traditions: sacred kings, diviners, priests, priestesses and healers, all of whom are integral to maintaining the balance in the cosmos.

The Yoruba conceive the world as two halves of a gourd — the one we live in and the one where the deities and ancestors live. In between these two spheres, there are forces, mainly malevolent in nature (ajogun, or warriors), as Wande Abimbola calls them, who must be constantly placated, sometimes with sacrifices, to prevent them from wreaking havoc on earth. In short, human devotional practices play a central role in regulating the activities of ajogun and in keeping the Yoruba universe in equilibrium.

Yancy: In the West, Indigenous African religions are often dismissed as “primitive” or “superstitious” by those who don’t know them. Can you give readers unfamiliar with African religious traditions some sense of the history and complexity of the Yoruba people and their culture?

Olupona: The Yoruba people, who live primarily in southwest Nigeria, are one of the largest ethnic groups in West Africa. Yoruba people are also found in the Republic of Benin, Togo, Sierra Leone and several other countries. As a result of the trans-Atlantic slave trade, between the 16th and 19th centuries, a large number of Yoruba were taken to the Caribbean, North America and South America, where they had significant influence on the culture and religion of the New World.

Yancy: So in some sense, influences of Yoruba culture and sensibility are already here in the West, and have been for centuries. What about the main population in Nigeria?

Olupona: The origin of the Yoruba in Nigeria is slightly more complex. According to the Yoruba origin myth, the world was created in the sacred city of Ilé-Ifè, where the Yoruba civilization blossomed in the ninth century and grew to become one of the largest empires in West Africa. While the Yoruba Empire Oyo is now acknowledged as the source of the standard and contemporary Yoruba language, culture and value system, it is to Ilé-Ifè (the ancient and sacred city of the Yoruba) that scholars now believe all other Yoruba settlements owe their unrivaled urban culture and robust cosmopolitan city states. Other origin myths allude to Yoruba migration from distant places to their current homes, but that has not been substantiated by archaeology or in the Yoruba culture more broadly.

Yancy: How do Yoruba believers think about the reality and meaning of death?

Olupona: Death as a palpable force looms large in the Yoruba religious and social consciousness. From cosmology to various ritual practices and genres of oral traditions such as proverbs, poetry and short stories are all brought to bear on the reality of death. Not a day goes by that speakers of the Yoruba language do not make mention of death as both a phenomenon and a certainty.

Among the Owo Yoruba people, Iku (death) is likened to the hippopotamus (eyinmi/erinmi), whose heavy weight no person can carry and whose presence one cannot run or escape from. This conveys the dilemma of a bereaved child who can neither carry the body of a deceased parent nor is courageous enough to abandon it, highlighting the helplessness of one when confronted by death.

In Yoruba folk tales, death is also portrayed as an old haggard man who carries a heavy club with which he kills his victims. No one is spared. The young, the old, kings, chiefs, commoners and the rich can all be his victims. It is assumed that at creation, and before individuals leave Orun (the otherworld), the preconscious mind is made aware of when death will strike in Aiye (this world), and when they will return to Orun. The appointed date, however, is never known.

Yancy: According to Yoruba, should human beings embrace death? And if so, how or why?

Olupona: It is assumed that death doesn’t end a person’s life, but instead marks a passage from one realm of existence to the next. Hence, the Yoruba believe there is an afterlife (or an “afterdeath”) in which the living dead exist as part of the sacred cosmos.

There is also an ambiguous response to death, depending on the circumstances surrounding the event. Death in very old age, for example, is welcomed as a fulfillment of one of the cardinal life quests. This form of death is celebrated by the community as a necessary transition to the ancestral world. On the other hand, deaths that occur in infancy, childhood or young adulthood are frowned upon and not often celebrated, because the deceased was yet to accomplish his or her mission on earth.

Deaths involving unnatural causes fall into the same category. It is by tradition a taboo for older people to participate in young people’s funerals, to ward off the malicious knell of death. This is also because the death of a younger person is considered “bad death,” not worth celebrating by the elderly. It is a taboo for kings (Oba) to witness funeral celebrations or behold a dead body.

Yancy: Is there an account within Yoruba that explains why we fear death?

Olupona: Absolutely. Yoruba personal names reveal a lot about why they fear death. Consider the following: Ikubamije, “Death has ruined me”; Ikubileje, “Death has wreaked havoc on our family”; Ikugbeye, “Death has taken away our dignity”; Ikumone, “Death is no respecter of persons”; Ikumofin, “Death does not recognize any law”; Ikupakin, “Death has killed the hero”; Ikupelero, “Death has killed a socialite”; Ikusika, “Death has committed acts of wickedness,” and so on.

The dead must also be called upon to avenge his or her own wrongful death. My maternal grandmother once told me a story of a great-uncle who was murdered on my grandfather’s farm while he was working and whose body was brought home for burial rites. My grandfather, being a devout Christian, was opposed to the rituals of “oku riro,” preferring to leave everything to God. Somehow, before the seventh day of the burial, the deceased avenged his own death by pursuing the murderer in his sleep. The murderer was said to have suddenly woken up from his sleep screaming as the deceased spirit “chased” him. Not long after, the murderer was reported to have collapsed and died!

Yancy: Are there specific circumstances under which we should fear death, according to Yoruba?

Olupona: Yes, especially when deaths are unusually frequent or inexplicable. The Yoruba are accustomed to finding causes of death and ensuring their non-recurrence. For example, they fear death of children known as “abiku” who are associated with “spirit children.”

These are children who are reincarnated to be reborn and die no matter what. These children are stuck in a perpetual cycle that prevents them from growing into adulthood. Death of spirit children defies the Yoruba mind so much so that abiku are said to confound even the most knowledgeable medicine men and women.

They also fear death that occurs in mysterious circumstances such as when a couple dies the day after their wedding, a very experienced swimmer drowns and dies, a ruler dies shortly after ascending the throne, a perfectly healthy individual dies suddenly without any apparent signs of sickness, or all of one’s children or siblings dying on the same day, even though they are all located in different places. All of these examples make one reflect on the significance of Yoruba personal names like Ikudefu, “Death has become a wind”; Ikuosunwon, “Death is not nice”; and Ikujaiyesimi, “O Death, let the community have a breathing space” and Ikudabo, “O Death, please stop.”

Yancy: Is there a relationship between how we live our lives here on earth and what happens after we die?

Olupona: In traditional Yoruba cosmology, there seems to be no explicit reference to final judgment as in Islam and Christianity; humans are enjoined to do well in life so that when death eventually comes, one can be remembered for one’s good deeds. One’s character may be measured in terms of virtue and vice, or in deeds that are worthy of reward. For the Yoruba, this is the core essence of religion.

For example, a prosperous and successful individual can be said to be reaping the good deeds of his/her deceased parents during their lifetime. Likewise, an individual who suffers may be said to be reaping the bad deeds of his or her deceased parents. So, it is assumed that the descendants of a wicked individual may live to reap the punishment meant for his/her parents. Yoruba religion shares this idea with Christianity as in the account of a worthy man of note in the Old Testament book of Ecclesiastes, Chapter 44.

Yancy: How do the Yoruba let go and grieve those who have died?

Olupona: The Yoruba spend an awful lot of time and energy on burying their dead. It is assumed that a “proper” burial is required, not only to ensure the deceased’s peaceful transition to the world of the ancestors, but to ensure that those of the living are not affected by death’s visit. Burial ceremonies and rituals may take up to an entire week and involve the deceased extended and immediate family, their lineage and clan, residents of their town and ultimately the whole community.

In certain places, it is also assumed that the dead must be encouraged to depart quickly and visit the open market (Oja) where they may make appearances as spirits. Among the Owo Yoruba people, it is believed that the dead, through a journey back home, must first return to the sacred city of Yoruba creation, Ilé-Ifè, on their way to the ancestral realm.

In the Owo Yoruba tradition, where age groups are well established, burial rituals and ceremonies are taken seriously. The members of these age groups are responsible for digging the graves of their peers or their peer’s parents who have passed on to ensure that they are properly buried. Hence, the Yoruba would say, “Eni gbele lo sinku, eni sunkun ariwo lo pa.” Literally — “It is the gravediggers who are the real mourners; relations who shed tears are merely making loud noises.”

Complete Article ↪HERE↩!

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Ethicist Says Talking About Death Isn’t Morbid

— But More Like The ‘Birds And The Bees’

Headstones in Calvary Cemetery in the Borough of Queens in New York

By Tonya Mosley and Allison Hagan

During a global pandemic, it may be surprising that more people aren’t talking about death and specifically, their final wishes.

Dr. Lydia Dugdale has been seeing this scenario play out over the past year with some of her patients in New York. Dugdale is a medical ethicist and explores the concept that part of living well is “dying well” in her book, “The Lost Art of Dying: Reviving Forgotten Wisdom.”

People spend their entire lives fighting back against death as part of the human condition. Some doctors may fear death, too, but physicians need to talk with patients about their end of life wishes especially during the pandemic, she says.

When patients come in for annual physicals, Dugdale asks if they want to talk about their end of life wishes — and most people say no.

“However, when we get talking, people realize that this is something important, that dying well is very much wrapped up in living well,” she says. “And in order to die well, we have to make some active decisions now while we’re healthy.”

Many people want someone to open the door to this conversation but don’t know how to start it themselves, she says.

The pandemic has raised concerns about ventilators and dying alone in the hospital. One of the biggest obstacles of this challenging time is providing dying people with community and family despite COVID-19 precautions, she says.

In her book, Dugdale shares some forgotten wisdom from the 14th century bubonic plague outbreak. Historians estimate that the “enormously devastating” outbreak killed as many as two-thirds of Western Europeans, she says.

In the 1300s, people approached the possibility of death in some eerily similar ways compared to today.

Some people decided to live large and indulge in hedonism without fretting over the looming possibility of disease and death. This group is comparable to travelers who faced criticism for going on spring break trips early on in the coronavirus pandemic, she says.

Others didn’t leave their house or engage with their community at all during the plague in hopes of earning “divine retribution,” she says. People didn’t know that bacteria caused the plague, but they understood venturing outside could result in getting sick. During the coronavirus pandemic, some people similarly haven’t left their houses at all or only a few times.

The final group of people tries to strike a balance between living life and recognizing the inevitability of death. These individuals continue to engage with society in a wise, prudent way to protect themselves and others, Dugdale says.

“Whether it is plague or pandemic or famine or war, we all are facing our mortality,” she says. “Death has been and always will be 100%.”

“The Lost Art of Dying: Reviving Forgotten Wisdom” by Lydia Dugdale.

Here & Now host Tonya Mosley’s grandmother always taught her that death is a part of life. Dugdale writes that conversations around death should mirror the birds and the bees chat, but she sees generational differences around talking about death in her patients and family members.

Dugdale’s grandfather returned from fighting in World War II and immediately secured cemetery plots. He made ongoing jokes for years about his relationship with the undertaker and threatened to write people out of his will depending on matters such as getting a tattoo he didn’t like, she says.

“But this idea that we need to, just as a matter of practical import, get ready for death is something that really feels like we’ve lost in the younger generations,” she says.

Everyone has a role to play in talking about living and dying well, she says. One common misconception around talking about death is that the conversation should occur close to the end of someone’s life.

People need to prepare to die well when they’re still healthy, she says. For some people that means fulfilling medical wishes such as do-not-resuscitate orders or planning to die at home. If someone wants to die at home surrounded by loved ones, Dugdale says to question if they’re investing in those relationships now.

Death also brings questions about the meaning of life and what happens afterward. Trying to seek answers on your deathbed is difficult, so Dugdale advocates for taking some cues from the Middle Ages.

“We should do this work now,” she says. “And so even engaging these questions of living and dying well — about what life means in the context of our communities over the course of a lifetime — is the best way to work toward a good death.”

Complete Article ↪HERE↩!

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Cancer, Religion and a ‘Good’ Death

It is hard to know how much my patient, caught in an eternal childhood, understood about his cancer.

By Mikkael A. Sekeres, M.D.

When I first met my patient, three years ago, he was about my age chronologically, but caught in an eternal childhood intellectually.

It may have been something he was born with, or an injury at birth that deprived his brain of oxygen for too long — I could never find out. But the man staring at me from the hospital bed would have been an apt playmate for my young son back home.

“How are you doing today, sir?” he asked as soon as I walked into his room. He was in his hospital gown, had thick glasses, and wore a necklace with a silver pendant around his neck. So polite. His mother, who sat by his bedside in a chair and had cared for him for almost half a century, had raised him alone, and raised him right.

We had just confirmed he had cancer and needed to start treatment urgently. I tried to assess what he understood about his diagnosis.

“Do you know why you’re here?” I asked him.

He smiled broadly, looking around the room. “Because I’m sick,” he answered. Of course. People go to hospitals when they’re ill.

I smiled back at him. “That’s absolutely right. Do you have any idea what sickness you have?”

Uncertainty descended over his face and he glanced quickly over to his mother.

“We were told he has leukemia,” she said. She held a pen that was poised over a lined notebook on which she had already written the word leukemia at the top of the page; I would see that notebook fill with questions and answers over the subsequent times they would visit the clinic. “What exactly is that?” she asked.

I described how leukemia arose and commandeered the factory of the bone marrow that makes the blood’s components for its own sinister purposes, devastating the blood counts, and how we would try to rein it in with chemotherapy.

“The chemotherapy kills the bad cells, but also unfortunately the good cells in the bone marrow, too, so we’ll need to support you through the treatment with red blood cell and platelet transfusions,” I told them both. I wasn’t sure how much of our conversation my patient grasped, but he recognized that his mother and I were having a serious conversation about his health and stayed respectfully quiet, even when I asked him if he had questions.

His mother shook her head. “That won’t work. We’re Jehovah’s Witnesses and can’t accept blood.”

As I’ve written about previously, members of this religious group believe it is wrong to receive the blood of another human being, and that doing so violates God’s law, even if it is potentially lifesaving. We compromised on a lower-dose treatment that was less likely to necessitate supportive transfusions, but also less likely than standard chemotherapy to be effective.

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“Is that OK with you?” my patient’s mother asked him. I liked how she included him in the decision-making, regardless of what he could comprehend.

“Sounds good to me!” He gave us both a wide smile.

We started the weeklong lower-dose treatment. And as luck would have it, or science, or perhaps it was divine intervention, the therapy worked, his blood counts normalized, and the leukemia evaporated.

I saw him monthly in my outpatient clinic as we continued his therapy, one week out of every month. He delighted in recounting a bus trip he took with his church, or his latest art trouvé from a flea market — necklaces with glass or metal pendants; copper bracelets; the occasional bolo tie.

“I bought three of these for five dollars,” my patient confided to me, proud of the shrewdness of his wheeling and dealing.

And each time I walked into the exam room to see him, he started our conversation by politely asking, “How’s your family doing? They doing OK?”

Over two years passed before the leukemia returned. We tried the only other therapy that might work without leveling his blood counts, this one targeting a genetic abnormality in his leukemia cells. But the leukemia raged back, shrugging off the fancy new drug as his platelets, which we couldn’t replace, continued to drop precipitously:

Half normal.

One-quarter normal.

One-10th normal.

One-20th normal.

He was going to die. I met with my patient and his mother and, to prepare, asked them about what kind of aggressive measures they might want at the end of life. With the backdrop of Covid-19 forcing us all to wear masks, it was hard to interpret their reactions to my questions. It also added to our general sense of helplessness to stop a merciless disease.

Would he want to be placed on a breathing machine?

“What do you think?” his mother asked him. He looked hesitantly at me and at her.

“That would be OK,” he answered.

What about chest compressions for a cardiac arrest?

Again his mother deferred to him. He shrugged his shoulders, unsure.

I turned to my patient’s mother, trying to engage her to help with these decisions. “I worry that he may not realize what stage the cancer has reached, and want to avoid his being treated aggressively as he gets sicker,” I began. “Maybe we could even keep him out of the hospital entirely and allow him to stay home, when there’s little chance …” My voice trailed off.

Her eyes above her mask locked with mine and turned serious. “We’re aware. But we’re not going to deprive him of hope at the end …” This time her voice trailed off, and she swallowed hard.

I nodded and turned back to my patient. “How do you think things are going with your leukemia?”

His mask crinkled as he smiled underneath it. “I think they’re going good!”

A few days later, my patient developed a headache, along with nausea and dizziness. His mother called 911 and he was rushed to the hospital, where he was found to have an intracranial hemorrhage, a result of the low platelets. He slipped into a coma and was placed on a ventilator, and died soon afterward, alone because of the limitations on visitors to the hospital during the pandemic.

At the end, he didn’t suffer much. And as a parent, I can’t say for certain that I would have the strength to care for a dying child at home.

Complete Article ↪HERE↩!

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‘Dear Life’ explores the beauty of end-of-life experiences

By Terri Schlichenmeyer

Before the doctor opened her mouth, you knew this wasn’t going to be good.

And it wasn’t, although you can barely remember what happened a minute after you heard the diagnosis. All you could wrap your head around were monitors and tubes and machines and death, when what you needed was “Dear Life” by Rachel Clarke, and a reminder that it wasn’t time for that yet.

When she was a little girl, Rachel Clarke was in awe of her father, a doctor who loved music and nature and who shared his sense of curiosity with his children. As a teen, Clarke toyed with the idea of following in his footsteps, but she chose a career in television instead. And then one day, after experiencing a couple of close brushes with death, she decided to go back to school to become a doctor, specializing in palliative medicine.

“I learned that dying, up close, is not what you imagine,” she says. “It is the essence of living… that really matters…”

About death, there are two main things: unlike our ancestors, we aren’t used to it; and we can’t know what it’ll be like. These are what Clarke helps her patients and their families deal with, and while she can’t answer the latter question, she promises them that the days and hours before the end are as full of life as possible.

Sometimes, that means meeting fears head-on, and discussing death matter-of-factly. Sometimes, it’s asking questions of a patient because no one else has done so. Caring for someone who’s dying may mean literally opening a window to sunshine or birdsong, holding a hand, letting “a wife curl up in a hospital bed beside her dying husband,” or encouraging a visit from a pet or a beloved grandchild. And sometimes, a doctor just needs to remember that “There is always a spark of beauty or significance…in the life you have left,” even when the person dying is someone the doctor loves.

This year, no doubt, you’ve seen enough death to last several lifetimes, and you’re not sure you can withstand a book about it right now.

But hold on, because “Dear Life” lives up to its title.

Beautiful, thoughtful, and loving, this book is absolutely brimming with life as author Rachel Clarke describes the end-of-life care offered at the hospice where she works and some of the most memorable patients to whom she ministered care.

If that sounds like an anti-life book, well, it’s not. It’s true that people die in this book, and they do it often but Clarke’s accounts of their days prior to death are quiet and serene, with no fear, no pain, and the minimum of loose ends left. Her workplace is not a sterile, clinical home where people go to die; rather, it’s a place where people die but first, happiness sneaks in sometimes.

And for that, curiously, this book on death-and-life may be the balm your COVID-bruised mind needs now. Indeed, calm, truthful, and not too gory, “Dear Life” is good.

Another book to look for is “Grief: The Biography of a Holocaust Photograph” by David Shneer. It’s the story of a photo taken toward the end of World War II, and the emotion inside it. Part meditation, part history, this book is perfect for the historian, too.

Complete Article ↪HERE↩!

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What to Do When a Loved One Dies

Advice to keep a sad event from becoming even more painful

By Consumer Reports

Responsibility for the various actions can be divided among family members and close friends of the deceased.

Immediately

1. Get a legal pronouncement of death. If no doctor is present, you’ll need to contact someone to do this.

  • If the person dies at home under hospice care, call the hospice nurse, who can declare the death and help facilitate the transport of the body.
  • If the person dies at home unexpectedly without hospice care, call 911. Have in hand a do-not-resuscitate document if it exists. Without one, paramedics will generally start emergency procedures and, except where permitted to pronounce death, take the person to an emergency room for a doctor to make the declaration. Keep in mind that do-not-resuscitate laws vary at the state level and if a person does not want to be resuscitated, “calling 911 is not necessary” according to the National Institute on Aging. “If the death is not unexpected, you might call the individual’s physician first,” says Lori Bishop, vice president of palliative and advanced care at the National Hospice and Palliative Care Organization.

  • 2. Arrange for transportation of the body. If no autopsy is needed, the body can be picked up by a mortuary (by law, a mortuary must provide price info over the phone if you ask for it) or crematorium.

    3. Notify the person’s doctor or the county coroner.

    4. Notify close family and friends. (Ask some to contact others.)

    5. Handle care of dependents and pets.

    6. Call the person’s employer, if he or she was working. Request info about benefits and any pay due. Ask whether there was a life-insurance policy through the company.

    Within a Few Days After Death

    7. Arrange for funeral, memorial service, and burial or cremation. Search the person’s documents to find out whether there was a prepaid burial plan. Ask a friend or family member to go with you to the mortuary. Prepare an obituary.

    8. If the person was in the military or belonged to a fraternal or religious group, contact that organization. It may have burial benefits or conduct funeral services.

    9. Secure the person’s home. Or ask a friend or relative to keep an eye on it, answer the phone, collect mail, throw food out, water plants, and keep minimal heat on to avoid frozen pipes if it’s winter in a colder climate.

    Up to 10 Days After Death

    10. Obtain the death certificate (usually from the funeral home). Get multiple copies; you’ll need them for financial institutions, government agencies, and insurers.

    11. Take the will to the appropriate county or city office to have it accepted for probate. Check your state’s laws, which may require you to file the will within a set period of time.

    12. If necessary, the estate’s executor should open a bank account for the deceased’s estate.

    13. Contact the following:

    • A trust and estate attorney, to learn how to transfer assets and assist with probate issues.
    • Police, to have them periodically check the deceased’s house if vacant.
    • An accountant or a tax preparer, to find out whether an estate-tax return or final income-tax return should be filed.
    • The person’s investment adviser, if applicable, for information on holdings.
    • Banks, to find accounts and safe deposit box.
    • Life insurance agent, to get claim forms.
    • The Social Security Administration (800-772-1213; ssa.gov) and other agencies from which the deceased received benefits, such as Veterans Affairs (800-827-1000; va.gov), to stop payments and ask about applicable survivor benefits. The SSA, like the VA, recommends immediately reporting the person’s death, though in many cases the funeral home will handle this.
    • Agency providing pension services, to stop monthly checks and get claim forms.
    • Utility companies, to change or stop service, and Postal Service, to stop or forward mail. Reach out to other companies to stop recurring bills and subscriptions. If home is vacant, contact the insurer to switch to a vacant policy. If home is under a mortgage, contact the lender.
    • The IRS, credit-reporting agencies, and the DMV to prevent identity theft.
    • Social media companies, such as Facebook or LinkedIn, to memorialize or remove an account.

    Know the Person’s Wishes

    For an elderly friend or relative:

    • Know the location of the will, birth certificate, marriage and divorce certificates, Social Security information, life-insurance policies, financial documents, and keys to safe deposit box or home safe. Ask the person to create an inventory of their digital assets (such as email, social networks, and digital files) and include a plan for these assets in their will.
    • Ask about the person’s wishes concerning funeral arrangements, organ and brain donation, and burial or cremation.
    • Have the person complete an advance directive, including a living will, which specifies wanted and unwanted procedures. The person should also appoint a healthcare proxy to make medical decisions if he or she becomes incapacitated. Some who are more seriously ill might also consider a Physician Orders for Life-Sustaining Treatment in addition to an advance directive.
    • Ask the person about end-of-life care, such as palliative and hospice care (which have key differences), and what their insurance will cover. Medicare, which covers most elderly Americans, will cover hospice care. Palliative care is growing in popularity, but “keep in mind that anyone with six months or less to live should have access to hospice,” Bishop says.
    • Have a do-not-resuscitate order drawn up if the person desires. That tells healthcare professionals not to perform CPR if the person’s heart or breathing stops and restarting would not result in a meaningful life.
    • Make sure the person gives copies of the documents to his or her doctor and a few family members or friends. Take the documents to the hospital if the person is admitted.

    Complete Article ↪HERE↩!

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How To Analyze 4 Common Dreams About Death & Dying

By Catharine Allan

How many times have you had a dream that involved death? Have you ever dreamed about someone you loved dying or been visited in a dream by someone who has passed away? Though we don’t often talk about them, I’d say that death is a common dream theme—especially this year.

Dreams are, after all, a way for us to process life. And dreaming about death is often a way to process the fear of the unknown. Morbid dreams can show up when we are in the middle of a job transition, a divorce, an identity crisis, or any other kind of major shift. In 2020, we are all going through a transformation on some level. We are all connected, so on some level, we are all affected.

Generally speaking, dreaming about death is likely a sign that you are in a period of change, but here’s how to further interpret this type of dream based on the details.

If you dreamed about a loved one dying:

If you’ve ever had a dream of a loved one dying, you know how utterly upsetting they can feel. You wake up wondering if it’s a premonition, a warning of an accident—you name it. Once this panic is activated, it becomes extremely hard to be objective.

So the first thing I would do if I dream of someone I know dying would be to ask myself if I am afraid of losing that person. If the answer is yes, this dream may have served as a wake-up call about how much this relationship means to me.

Start there and see if your body drops the tension and you stop obsessing over that dream.

If you dreamed about yourself dying:

This can be a very scary dream or a very tranquil dream, depending on its quality. I’ve heard of people who have dreamed that they’ve died and been met by spirits, angels, ancestors, or guides and experience peace. I’ve also heard from people who dream of painful deaths that occur under scary circumstances. So it’s complex, and ultimately the only person who can decode the meaning behind this dream is you. But here is an example of how I would approach a dream like this:

Let’s say I had a dream that I died in the water, drowned when I fell into the sea. If I felt peace and calm in my dream and like my spirit was at rest, I might come to the conclusion that this dream was about a past life.

If I had the same dream but I struggled for air, felt alone and in despair, this would obviously be a bad death. In this case, I would try to remember some more details of the dream. What was the scenario that caused me to fall overboard? Was I pushed? Were large waves washing me away?

I would look for more clues about what the message could be and how this dream could be signifying a different kind of “drowning” in my own life.

If you had a nonsensical dream about death:

When we are processing many emotions at once—fear, sadness, loss, frustration, desire, longing, etc.—our dreams often become giant mashup scenarios. They don’t make much logical sense. One minute, it’s the 1980s and you’re wearing the pants you bought online last week. The next minute your ex from five years ago is there, and suddenly you see your dying fall.

When timelines are mixed, people past and present are juxtaposed, and you can’t put the dream in any logical order, that’s your psyche processing your waking life. That’s the one for the analyst’s couch or the dream books. Its message is always personal and only clear after a lot of inner reflection. If you die in this kind of dream, it’s likely pure fear of change or loss.

If you dream of someone you love dying in a similarly haphazard way, the same criteria apply. If the story is convoluted and the steps are mixed up in time and space—and especially if you wake up instantly emotional and confused—this is not a predictive dream. You might just be feeling scared to lose this person, literally or emotionally.

(I do believe that some highly intuitive people can have predictive dreams, but these tend to be very matter-of-fact, detailed, and orderly. You wake up with a clear, concise flowing story, and you don’t feel emotional about it.)

If you dreamed about someone who has passed away in real life:

If the dream is confusing, has mixed-up timelines, and causes you to wake up feeling sad or confused, it’s likely you processing their loss.

If that person is happy and at peace in the dream, maybe talking to you or showing you something, and you wake up feeling calm, it could have been a visitation from them. And those are the best dreams of all.

Dreams are a common way for us to process our waking life. So most of the time dreams about death are not about literal death but the challenges and unknowns we are facing. Pay attention to the details of your death dreams and how they make you feel for further insights into their messages.

Complete Article ↪HERE↩!

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What you need to know if you or a loved one requires end-of-life care

By Ben Poston, Kim Christensen

Conceived as an end-of-life option for terminally ill patients, hospices provide palliative care, medications, nursing services and counseling for those diagnosed with six months or less to live.

The number of U.S. hospices has roughly doubled in the last 20 years, as more for-profit providers vie for a share of $19.2 billion a year in Medicare spending that covers hospice care. More than 1.5 million Medicare beneficiaries now receive care from some 5,000 hospices, nearly a quarter of them in California.

While hospice has been a godsend for millions of dying Americans and their families, a Times investigation found that intense competition for new patients has spurred billing fraud and other illegal practices, including falsified diagnoses and kickbacks to unscrupulous doctors and recruiters who target prospective patients at retirement homes and other venues.

The Times also found hundreds of instances in which California hospice patients were harmed, neglected or put at serious risk, their mistreatment sometimes exacerbated by serious gaps in government oversight.

What are the benefits of hospice care?

Hospice is intended to provide comforting, compassionate care and a range of support services for terminally ill patients and their families. In addition to nursing and medical care that includes pain management, prescription drugs and supplies, patients receive spiritual and emotional support, help with personal hygiene and respite care for family caregivers.

Most hospice patients receive care in their homes, including assisted-living settings and nursing facilities.

How do I choose a hospice?

There’s no set formula for choosing a hospice, although experts suggest discussing options with your personal physician and seeking recommendations from friends and relatives whose loved ones have had good experiences.

You should also interview any prospective hospice, asking questions about its licensing, which is required by the California Department of Public Health; whether it is certified by Medicare; when it was last inspected and whether violations were found; the range of available services; the makeup of the hospice care team and the roles of its doctors, nurses and others; and the role the hospice expects family members to play in a patient’s care plan.

Several industry and advocacy groups offer online guidance, including the National Hospice and Palliative Care Organization, which provides a worksheet and a list of questions.

How do I know if a hospice is reliable?

There is no one place where consumers can go to make a comprehensive comparison of local hospices — a gap that patient rights advocates have long criticized.

A variety of online sources provide information about hospice care, but each has limitations. Medicare’s hospice comparison site allows consumers to search for providers by ZIP Code or name, but has scant information about quality-of-care issues and inspections.

The California Department of Public Health has a searchable tool called Cal Health Find Database, which provides users with inspection reports when serious violations are uncovered back to 2017. It also allows consumers to compare quality metrics of up to three hospices at a time, but it doesn’t provide a rating system for providers. The results of inspections by accrediting agencies are not included on the site — a significant problem for consumers in California, where more than 80% of hospices contract with accrediting agencies rather than the state to conduct certification inspections once every three years.

Another resource that is more difficult to navigate is an interactive site maintained by the Centers for Medicare and Medicaid Services. The site includes copies of complaint investigations and a look-up function that allows users to compare the number of serious violations at hospices in California and other states.

What red flags should I look for?

Be on the lookout for any hospices that have been cited in recent years with serious violations. In the language used by Medicare, these include “condition-level” deficiencies or “immediate jeopardy” situations, which are considered the most severe. Also, hospices can be cited for failing to certify that patients are terminally ill, which is an indication of possible fraud.

If you have the name of a hospice administrator, which can be found on the state public health department’s website, you can find out if that person has been excluded from receiving federal healthcare payments on a site run by the U.S. Department of Health and Human Services’ Office of Inspector General.

If I’m not happy about my hospice, where do I complain?

If you can’t resolve your issues with the hospice, the California Department of Public Health investigates complaints, which can be filed online — but not necessarily with satisfying results.

You may also file a complaint about Medicare providers directly with the federal agency or with the California Senior Medicare Patrol, a federally funded statewide hotline to help Medicare beneficiaries prevent, detect and report fraud.