The Good Death

One Slide for End-of-Life Conversations

2010-11-24T18:10:00.000-08:00

So, for all of you who are already gathering with loved ones this holiday weekend, why not take some time to discuss your wishes for end-of-life care?

Engage with Grace has put together a helpful, simple, five-step slide to start the conversation.

New York Advance Cancer Patients More Likely to Die in ICU

2010-11-22T10:28:00.000-08:00

A study just published by Dartmouth College shows that advance stage cancer patients in New York state are more likely to die in an ICU than the average patient nationwide. In New York, more than 46% of these patients are dying in ICU, compared to 29% nationally.

The ICU care costs more and is a greater drain on state resources, and these cost issues are forcing the Healthcare Association of New York State to take notice of this disparity. So, we may have a case in which a bankrupt healthcare system is pushing us toward better end-of-life care for patients, in some instances. I think this section of the article sums the issue up nicely:

"Under pressure to cut costs, New York's hospital industry is finally welcoming a new focus on palliative care.

That means letting patients and their families know when medicine has reached its limits and spelling out the options, which include foregoing drastic interventions that would cause patients to spend their last days in expensive intensive care. Recognizing it's a sensitive issue, hospitals are making a point of saying they do not prevent patients from choosing interventions. The idea is to help people make the best choices for themselves, said Dr. Tia Powell, a medical ethicist at Montefiore Medical Center in the Bronx."

Personalizing your "deathbed"

2010-11-10T19:12:00.001-08:00

A fascinating article from the New York Times about people going to major lengths to create a personalized space in which to die. The individual examples are fun to read through. But more than that, I think this article is yet another reminder of the beautiful work that hospice caretakers and social workers do for the sick and dying every day. Because these scenarios would not be possible without their help.

P.S. This photo is just about my absolute nightmare scenario for where I could be when I die. Am I alone in this?

(Photo from NY Times.)

Top 50 Nursing Assistant Blogs

2010-02-16T19:18:00.000-08:00

Much thanks to NurseAssistant.org for including The Good Death in its listing of the Top 50 Nursing Assistant Blogs.

I am happy to be in such great company. If you scroll down the list to Hospice Care Blogs, you will see us listed amongst some of the best palliative-care focused blogs out there.

Thanks for the shout out!

Hospital Type and Likelihood of Feeding Tube Use

2010-02-14T08:41:00.000-08:00

A new study published in the Journal of the American Medical Association suggests that nursing home residents with advance dementia have starkly different odds of being given feeding tubes depending on which hospital they are sent to.

According to the study, some hospitals used feeding tubes in as many as 1 in ever 3 patients, while other hospitals used feeding tubes in as few as 1 in ever 100 patients.

Not surprisingly, hospitals that were more aggressive about providing end-of-life care were more likely to insert feeding tubes. Also, likely to use them were large hospitals and for-profit hospitals.

The sad implication of this study is that it suggests hospital protocols become more important in deciding end-of-life behaviors than family and patient wishes.

Here's a link to the JAMA abstract.

End-of-Life Planning

2010-02-07T20:34:00.000-08:00

Carla from Compassion and Choices raised an excellent point in the comments of another post. End-of-Life planning is rarely straightforward, and it's important to fully understand all sides of an issue before you make important decisions.

There are some potential flaws in the simplicity of the Five Wishes format (a form I previously blogged about). Barbara Coombs Lee has written a nice piece about it. While its clever branding makes it memorable, and the positive framing of "wishes" is a nice language to cast death planning within, the form does have bent toward prolonging life that will not work for everyone.

The form does not allow doctors to withhold any treatment with the intent of taking your life. And it could be argued that many such behaviors than would be spelled out in a living will or advance directive could be cast as taking a life.

I'm a firm believer that any planning is better than no planning because, at the very least, you're giving your loved ones some indication of your wishes, fully understanding the implications of the forms you are working with is important to having the kind of death you would like.

Palliative Care Grand Rounds

2010-02-07T20:29:00.000-08:00

Hi all!

Another edition of Palliative Care Grand Rounds is up at Alive Hospice Blog. It's a great overview of what has been going on in the world of palliative-care-related blogs.

Check it out!

The funeral industry in Taiwan

2010-01-24T21:19:00.000-08:00

A fascinating article from the New York Times about funeral practices in Taiwan—how elaborate the ceremonies are ... and how well paid the workers are. According to the article, a recent posting for 10 openings at a funeral home received 2,000 applications.

Five Wishes brought to Life

2009-11-19T19:39:00.000-08:00

Gail Rae from the mom and me journals dot net has applied the Five Wishes to her mother's recent passing, wondering how each question relates to the discussions she had with her mother before her death. It's a beautiful post and a great embodiment of just how the Five Wishes framework can work.

Palliative Care Grand Rounds

2009-11-19T19:18:00.000-08:00

If you've been wonder what palliative-care-minded bloggers are writing about, here's your chance to find out ...

I'm a little behind on posting this, but this month's Palliative Care Grand Rounds is up at Pallimed Arts & Humanities. If you're not familiar with it, PCGR is a monthly blog entry that highlights what has been going on in cyberspace regarding end-of-life issues, palliative care, death and dying, etc.

Next month, PCGR will be hosted by Death Club for Cuties (gotta love that name!).

Dying to Live out on DVD

2009-11-11T12:42:00.000-08:00

Ben Mittleman's exploration of facing his own mortality: Dying to Live, is now available on DVD. I highly recommend checking it out, if for no other reason than we can all occasionally use a reminder that we are all capable of so much more than we think.

Filling out my Living Will

2009-10-18T09:51:00.000-07:00

Which lines would you initial?

"If in the judgement of my physician, I am suffering with a terminal condition from which I am expected to die within six months, even with available life-sustaining treatment provided in accordance with prevailing standards of medical care:

__I request that all treatments other than those needed to keep me comfortable be discontinued or withheld and my physician allow me to die as gently as possible;

__I request that I be kept alive in this terminal condition using available life-sustaining treatment (THIS SELECTION DOES NOT APPLY TO HOSPICE CARE.)"

For me, it's pretty easy here. I initialed the first option. If I knew I was terminal, I would only want comfort care. The next question gets into more gray areas for me though.

"If, in the judgment of my physician, I am suffering with an irreversible condition so that I cannot care for myself or make decisions for myself and am expected to die without life-sustaining treatment provided in accordance with prevailing standards of care:

__I request that all treatments other than those needed to keep me comfortable be discontinued or withheld and my physician allow me to die as gently as possible;

__I request that I be kept alive in this irreversible condition using available life-sustaining treatment. (THIS SELECTION DOES NOT APPLY TO HOSPICE CARE.)"

I want to initial the first line, but I also really want to know what the condition would be. Doesn't everyone? I'm lucky; I have a great medical advocate as my medical power of attorney. I'm wondering how other people have worked through these topics though.

Another Harvest Moon

2009-09-12T20:06:00.000-07:00

I was alerted to this film in the comments section of a recent post.

And I just have to say, it's about freakin' time someone made a movie about life in a retirement home/assisted-living facility.

Also, it looks like the movie deals with quality-of-life issues, withholding treatment, and the right to die. I'm very curious to see it, and I hope others go to the movie and have lots of conversation afterwards.

Five Wishes

2009-09-12T19:55:00.001-07:00

Just found out about this website, Aging with Dignity.

They offer a living will written in everyday language, and they call it Five Wishes—because it helps you lay out your five wishes about end-of-life care.

*Who you want to make healthcare decisions for you when you can't make them

*The kind of medical treatment you want or don't want

*How comfortable you want to be

*How you want people to treat you

*What you want your loved ones to know

If you're looking to fill out your own living will, this is a very accessible resource. Please note, it meets the legal requirements in 40 states. But, the site also has a handy little map to show which states accept this form. Link to it here.

Update on Death with Dignity in Washington State

2009-09-08T21:51:00.001-07:00

Just a short piece in the Seattle Times giving some stats on what has happened under the first six months of Washington state's Death with Dignity Act.

Twenty two people have received prescriptions for life-ending drugs, and it seems 16 of them have since died. The article cites sources that claim 11 are known to have died from using the medication, as opposed to natural causes. (The state will not release information on how exactly specific people have died because of patient confidentiality laws.)

That's about all the article says, except for a couple of quotes from groups on either side. But it's only a few quick paragraphs if you want to check it out.

Is Assisted Suicide a Constitutional Right?

2009-09-01T06:38:00.000-07:00

That's the question Montana's State Supreme Court will take up on Wednesday.

It stems from the case of Robert Baxter, a 76-year-old retired trucker who died of lymphocytic leukemia. Baxter, while still alive, sought the right to die, and took his battle to the Montana court system. A lower court ruled in his favor, on the very day he died. The State of Montana appealed the decision and it has now reached the state's Supreme Court.

According to the New York Times:

"The legal foundation for both sides is a free-spirited, libertarian-tinctured State Constitution written in 1972 at the height of a privacy-rights movement that swept through this part of the West in the aftermath of the 1960s. Echoes of a righteous era are reflected in language about keeping government at bay and maintaining individual autonomy and dignity."

It seems now, not only is the right to die being advocated for from some of the more liberally minded states (Washington and Oregon), but now we're seeing a movement come out of a more conservative, individualistic state.

And we're seeing some different arguments because of the unique nature of Montana. For one, since so many people live in near isolation, opponents worry that the sick will be pushed into the law out of a lack of access to proper healthcare. Montana also already has one of the highest suicide rates in the nation, and some worry about enacting such a law in an area that already has problems with suicide.

On the flip side, proponents state the need for individualism and autonomy in decision making—the rights of the individual to direct his or her own fate.

This will be interesting to watch. And if the court does approve the assisted suicide, it will be interesting to see what type of law they come up with, since this move has not stemmed from a carefully drawn out initiative, the way Washington's and Oregon's laws did. Will they essentially copy Oregon's law, like Washington state did, or will they do entirely their own thing, which seems more in the character of Montana.

Ted Kennedy Wanted a Good Death

2009-08-27T08:23:00.000-07:00

A great NY Times piece about the way Ted Kennedy handled planning for his death—from his cancer treatment, to getting his advance directives in order, to spending his last nights eating ice cream and watching James Bond movies with his wife Vicki.

I'm happy Kennedy had the time and the foresight to plan his last days like this, and I hope others will think a little about doing the same when their time comes when they read this story.

A High-Profile Bioethicist!?!

2009-08-25T10:15:00.000-07:00

What did these parents feed their children? One is White House Chief of Staff, one inspired an HBO show about Hollywood agents, and the another has become maybe the first ever famous bioethicist.

The insanity of all of that aside, this NY Times piece on Dr. Ezekiel J. Emanuel and his role in advising President Obama's on healthcare legislation is a great read. If for no other reason, it is yet another example of how issues that need to be carefully, reasonably discussed get spun out into crazy, maddening, thoughtless rhetoric in the political arena.

Betsy McCaughey's Daily Show Appearance

2009-08-22T14:11:00.000-07:00

I'm posting Jon Stewart's interview with Betsy McCaughey, former Lieutenant Governor of the State of New York who is credited with starting the myth that the current healthcare reform bill will lead to senior citizens not getting medical care. In other words, she is the mother of the hysteria about elderly people being encouraged to sign DNRs even if they don't want to, being told they have to just sit back and die instead of receiving actual care.

And according to political gossip, McCaughey inspired Sarah Palin's controversial remark about "death panels."

The Daily Show With Jon Stewart

Mon - Thurs 11p / 10c

Betsy McCaughey Pt. 1

www.thedailyshow.com

Daily Show
Full Episodes

Political Humor

Healthcare Protests

The Daily Show With Jon Stewart

Mon - Thurs 11p / 10c

Exclusive - Betsy McCaughey Extended Interview Pt. 1

www.thedailyshow.com

Daily Show
Full Episodes

Political Humor

Healthcare Protests

The Daily Show With Jon Stewart

Mon - Thurs 11p / 10c

Exclusive - Betsy McCaughey Extended Interview Pt. 2

www.thedailyshow.com

Daily Show
Full Episodes

Political Humor

Healthcare Protests

The interview shows how complicated this bill is, but also, how easy it is for it to be twisted to one person or another's purposes. Also, it's a great interview on Stewart's part, if you can stand watching a little confrontation. He does an excellent job of cutting through her double-speak and forcing her to point to exactly where the bill says what she is claiming it says. (Which by the way, it doesn't.)

Apparently, McCaughey resigned her position on the board of directors of the Cantel Medical Corporation following this interview.

But here's a silver lining: Maybe this hyperbolic, fear-mongering spin is finally backfiring, and now, people will actually start to really think about living wills and advance directives in a serious and calm manner. We can hope, right :)

Medical Futility Statues

2009-08-20T20:51:00.000-07:00

Thaddeus Pope of Medical Futility Blog has worked on a piece that has just been published in a new book called The Many Ways We Talk About Death in Contemporary Society.

Thaddeus' piece is titled "Medical Futility Statues: Can They Be Resuscitated?" A full table of contents is available here.

Here's a publisher's description of the book as a whole:

"This interdisciplinary work examines the representation of death in traditional and 'new' media, explores the meaning of assassination and suicide in a post 9/11 context, and grapples with the use of legal and medical tools that affect the quest for a 'good death.' The contributors treat their interrelated topics from the perspective of their expertise in medicine, law, psychology, anthropology, sociology, political science, religion, philosophy, literature, media, and visual culture."

Congratulations Thaddeus. It looks like a fascinating read.

Euthanasia

2009-08-20T20:44:00.001-07:00

I wanted to share this with you all.

Hospice Physician in the comments section of last Friday's post, helped me clarify my paraphrased definition of euthanasia.

"To address your quote below:

'when a medical practitioner directly brings about death by administering medicine to the patient'

This is true but to clarify even more, euthanasia is a deliberate act with the intention of causing death in a patient. There is an ethical principal called the "Rule of Double Effect" which states, a medical practitioner is not acting unethically by giving pain medication, for example, that may lead to death, if the intent is not to cause death but to relieve pain/shortness of breath or promote comfort."

I'm always a fan of further clarity. Thanks Hospice Physician!

Details, please

2009-08-14T21:02:00.000-07:00

Newsweek has this piece that is supposedly debunking seven myths of the current healthcare debate.

While debunking the myth that the House bill requires suicide counseling, this article states:

"Euthanasia, on the other hand, is legal in only three states, making it even more unlikely to be a major part of the federal health plan."

Pardon me, Newsweek, but euthanasia is not legal in any state. But death with dignity is legal in a handful of states.

The proper terminology makes a huge difference. Euthanasia in general means a mercy killing, but in practice usually refers to when a medical practitioner directly brings about death by administering medicine to the patient. Most people think of what vets do with their pets when they hear the word euthanize.

Death with dignity is a more specific phrase that refers exactly to the recently passed into law procedures in which the patient is prescribed medicine that they can take on their own to bring about their own death, on their own terms, at their own time, when they're comfortable doing so. And all along, the patient can decide not to go through with the practice.

General euthanasia is not legal in any state. The specific act of death with dignity is legal in certain states.

Besides which, since death with dignity is such a heated topic, and something that has the potential to make a revolutionary difference in the amount of choice and control people have over the way in which they approach death, they manner in which we speak about it is incredibly important. We need to be careful about what we're referring to and be clear about what we're talking about. I realize this was a side issue in this article, but a news magazine should be better at articulating the details. Simply calling it euthanasia is flippant, careless, and inaccurate.

Death with Dignity Panels

2009-08-13T18:54:00.000-07:00

So, I've gone from thinking I wouldn't post anything on the healthcare-reform debate to posting on it twice in two days.

The Senate has removed the portion of their bill that allows Medicare to pay doctors for counseling sessions with patients regarding advance care and end-of-life planning. (Right now, it's still in the House version of the bill.)

Just to be clear, these counseling sessions are happening already. End-of-life planning often occurs when someone becomes terminal. Patients will sit down with their team to discuss their options for resuscitation, hospice care, pain management, comfort, etc.

What this particular bill provision addresses is not the actual conversation but Medicare coverage of the conversation. By paying doctors for time they are now not getting paid for, they may be encouraged to hold even more end-of-life consults—thus allowing more people to openly discuss how to create the best death possible for themself, making this blogger very happy.

And yet, proponents of it are pushing fear in our faces, speaking as though passage would magically make death come sooner. As though the government is going to be paying off doctors to tell patients it's time to go.

The American Medical Association supports this provision. The National Hospice and Palliative Care Organization supports this provision. These are two highly reputable organizations. Plus, to insinuate that individual doctors would go against their ethical, sworn duty to "first do no harm" and actually give up on patients because they're given money from Medicare, is incredibly insulting.

Sarah Palin has infamously gone so far as to call these "death panels," which is so absurd, I don't even know how to address the claim.

When I hear these arguments, I can't help but flash back to some of the anti–death with dignity arguments.

One of the big arguments against death with dignity—one of the fallacy, weak arguments—is that insurance companies will use the legislation to push people into death so that they don't have to pay for continued treatment. (Remember the Martin Sheen ad?)

Well, if you replace "insurance company" with "the government" and "death with dignity" with "healthcare reform," this is basically the same argument being paraphrased and reshot at us.

It's inaccurate, and it's fear-based, and it's a shame that it looks like it might pull the public away from more information and better choices.

When it's Your Neighborhood

2009-08-13T17:13:00.000-07:00

I was just reading details about the 72-year-old shopkeeper in Harlem who killed two robbers while defending his shop.

I'm shocked by how violent this whole situation is, even for New York City, even for Harlem—which you know if you've lived in New York, can be pretty good or can be pretty bad, depending on which block you're on. And I never knew Harlem well enough to know how this particular block is.

But even if it were a rough neighborhood, for four men to enter a shop in the middle of the afternoon, announce their intent to rob the place, and pistol whip one employee, and then for that to be followed by the elderly shop owner opening fire with a shotgun on all four robbers, killing two and injuring the others. Man! That's graphic.

I feel bad for the neighborhood. Something like that would be tough to shake off. It would be difficult to go back to the illusion of safety and invincibility—something we all need to some extent to go through everyday life.

Once, when I lived in Seattle, there was a fatal police shooting on my street. Just that left me feeling like an exposed nerve for a couple of weeks. I don't know how you would reclaim your sense of home and community after having this down the street.

Take a Pain Pill

2009-08-11T19:06:00.001-07:00

Hospice Blog has an excellent post today about President Obama use of the term "end-of-life care."

The Hospice Guy has noticed that Obama uses end-of-life care to refer to the elderly simply seeking healthcare, instead of differentiating between people who are actually in their last days, needing care that will take them through to their death. And in so doing, he worries that Obama is confusing the intent of hospice as a place where people can go to die in peace and as much comfort as possible once they have CHOSEN to die.

As the Hospice Blog points out, Obama's use of the term is almost a window into how little he really knows about the day-to-day realities of the medical world. And whether you're for or against public healthcare, it's a little scary to think of anything but the utmost experts revising our healthcare system. Here's the video he shares.

(Please note: the title of this YouTube film is misleading. Obama is, of course, not that dismissive to the woman.)

The woman asked if her mother, at 99, could have had a pacemaker under public healthcare, even though she was old because she had much higher than normal quality of life. I think the bigger question she was getting at was, what if it looks bad on paper, but when you see the patient in person, you can understand where a procedure makes sense—hence the reason she says, "A picture is worth a thousand words." And Obama's answer is disappointingly to infer that the surgery was not going to help (even though it did) and to tell her mother to take a pain pill!?

He's telling her, no, right? I've watched this about five times trying to get through the political speak, but that's what's happening here, I think. He's saying, no, in essence, that the bigger concern is trimming the waste from the healthcare system and her individual mother matters less? Other interpretations?

I love that people are discussing healthcare in such a high-profile way right now—especially when it comes to end-of-life matters like resource allocation in the last years, what constitutes quality of life that is good enough, etc. But I hate that the discussion is being handled with such vitriol. And I hate even more that a bunch of politicians, mostly constitutional lawyers, with voters and elections on their minds are going to decide how healthcare issues should be managed.

I hope the legislators are consulting some good healthcare professionals behind the scenes.

Never trust a corpse

2009-08-07T19:11:00.000-07:00

I meant to catch this movie at the Seattle International Film Festival, but just didn't get around to it. So I'm excited to see this review at NPR.org; it gives me hope that wider release is on the way, and I might get a second chance.

I Sell the Dead recounts the exploits of two grave robbers as one of them is about to face the guillotine for his crimes. The horror film is supposed to be more comedy than gore, which is why I'm interested ... not to say that it isn't ghoulish and frightening.

During SIFF, it played at a midnight showing, and from what I can glean, that pretty much characterizes the type of movie this is: fun, startling, a little gross, not too serious, dealing with the undead. What more could you want in the witching hour?

It is directed and written by Glenn McQuaid and stars Dominic Monaghan and Larry Fessenden.

Here's the trailer.

Palliative Care Grand Rounds

2009-08-05T19:41:00.001-07:00

The latest edition of Palliative Care Grand Rounds is up at Risa's Pieces, the thoughtful blog written by Risa Denenberg.

Lots of great links to bloggers taking on the current healthcare discussion, in terms of end-of-life issues. And as always with PCGR, links to new bloggers you probably didn't realize were out there.

New Blog from a Hospice Physician

2009-08-04T18:38:00.000-07:00

Check out this brand new blog (started July 19th) called Hospice Physician's Blog.

As the title suggests, it's written by a hospice physician, and has entries on the doctor's experience explaining the benefits of palliative care to reluctant family members, whether chemotherapy is always used in the most effective way, and whether physicians always know when their patients are dying.

It's always good to have another palliative-care focused blog in the community.

Death Etiquette

2009-07-31T19:28:00.000-07:00

Is there such a thing as death etiquette? If not, there certainly should be. Too many of us just have no clue what to say when someone is ill or has a recently deceased family member.

A mortality-related etiquette question from this week's Social Q's column in the New York Times.

"Did He Just Say That?

My mom was found to have stage III ovarian cancer. We’ve been moved by the many notes of support we’ve received. But one comment caught us off guard: Not long after my mother finished chemotherapy, the husband of an old friend asked, “What’s it like being so close to death?” What should we have said?

Anonymous, New York

Make that three sure bets in this world (to go with death and taxes). Sometime or another, we all say the worst thing at the worst moment.

I hope your mother wasn’t too upset.

Depending on the closeness of the gathering, and your mother’s mood that night, she (or you, if she was too dumbstruck) could have shared some of her feelings or replied that she was focusing on happier prospects. She might even have made the ultimate point: Cancer may have put a finer point on her mortality, but that doesn’t mean that you, I or Mr. Foot-in-Mouth know any better when ours will strike."

Fran Johns has a new blog

2009-07-30T19:52:00.000-07:00

A sign of how out of the loop I've been lately (due to a cross-country move), Fran Johns has a new blog, and it's taken me a month to notice.

But enough about me: The blog is excellent.

Fran focuses on issues facing the elderly, and Baby Boomers who have elderly parents. The current post shares the thoughts of a retired California physician on Death with Dignity now that he is facing his own mortality. It's amazing!

Other posts address housing options for seniors and palliative care.

The site doesn't load real well format-wise on my Mac computer, but it looks like the site is still in beta testing, and it's worth bearing with any format issues to get to the content. Fran is one of my favorite writers in the blogosphere, and I try to read every word she posts. Trust me; she's that good.

Email from a Cancer "Survivor"

2009-07-30T19:36:00.000-07:00

The following is an email that I received from a cancer patient named Georgiana. I am publishing it with her permission, although I tried to remove identifying characteristics, I am leaving the remainder of the email unedited. Georgiana, my apologies for taking so long to get this up on the blog.

I hope you find her words as valuable as I do. Georgiana mentioned to me that she is considering starting her own blog, and I really wish she would because she definitely has a perspective and a story to share.

"I am Georgiana McAdams, a 67 year old mother of 4 widely scattered children and a supportive,loving husband of 45 years. In 9-05 I was diagnosed with stage 1V rectal cancer - pathology from resection surgery showed progression to the liver. After a visit to -- Cancer Center and literally hundreds of hours of research into my particular cancer, I opted for nothing more than palliative care with an oncologist. No chemo - no radiation - nothing. I should mention I am not a professional, but have studied medicine passionately for many years. Currently I am entering "the big adventure" and uncharted territory as my liver functions are deteriorating and I have ascites and ankle swelling (being managed). I fully know what to expect right down to the very end and am in total acceptance. It's the little things that get you down - not fitting into your favorite jeans - or finding your favorite shoes are too small due to fluid accumulation, pain when bending due to tumor pressure, etc. I also have a small tumor in my left lung now. However, -- (Cancer Center) gave me 6-9 months in Jan. of '06 and my oncologist, based on current labs, says about 6 months now - that was in March. I think I will make it a little longer. Main point is my surgeon, oncologist and PCP will
tell you I gave myself a better QOL than they could have. I should also mention I broke my shoulder 2 years ago
and last June broke my hip (pinned). While I am slower I still manage to get out most days. I am ready for hospice
whenever it comes and have my family fully educated on what to expect so that there will be no undue hysteria
over what will be the normal process of dying. Please understand I am not advocating my choices for anyone else - it simply was the right one for me despite medical pressure in the beginning to do otherwise. My dilemma is communication with other people who see me as giving up the fight (although any doctor I talk to says they would do it my way) or simply not discussing the horrid, big "C" word. We really do need to change our views about death and the dying process. It is a normal and totally natural conclusion. I currently know several people who have lost a loved one and in each case, there were last ditch, invasive procedures, costly moves to yet another trial center, etc. These poor people should have simply been brought home and left to die in peace surrounded by supportive family. I am actually looking forward to hospice as then there will be the opportunity to talk it all out with someone who understands from a medical viewpoint. Lord knows, my poor husband has willing suffered
through too many hours of this and I just refuse to burden him further. He has heavy cardiac problems and is a doll nevertheless. Our local Cancer Support Group is a joke and again no one seems to understand my position of "do nothing". They say once you have cancer, a day will not go by without you thinking about it. Well, I can actually forget it for a week or two, although daily I have pain issues in various places, but I don't think cancer pain, I think shoulder pain (tumors pressing on the diaphragm) or abdominal pain or leg pain, etc. I am absolutely sure that if
I had opted for chemo, followed by liver resection (Not even sure I was a candidate due to location of tumors) and then hepatic artery infusion, I would have been long gone. Instead I have had over 3 and 1/2 years of decent QOL, if not prime. There are always "new normals". There was a time when you were considered a survivor if there was NED after 5 years. I understand that now you are a survivor if you have cancer and are still alive. How can I possibly
consider myself a survivor? It simply isn't to be and that's really O.K. ... I am doing my
best to educate people, where I can."

Michael Jackson Cupcake

2009-07-16T11:52:00.001-07:00

I was just in Austin, Texas, and of course found my way to the local cupcake shop, Hey Cupcake. One of Hey Cupcake's specialties is the Michael Jackson cupcake. They have had this item on their menu for years. What is it? A chocolate cupcake with cream cheese frosting. Get it? It's both black and white, playing on Michael Jackson's confused racial complexion.

After his recent passing, Hey Cupcake was apparently worried that they might need to take the item off of their menu out of respect for Jackson. But surprisingly to them, sales went through the roof. People were buying the cupcake out of tribute to Jackson. Even though it was a joke item, patrons see it as a way to recognize him instead of being tacky.

Mourning Public Figures

2009-07-07T10:32:00.000-07:00

Inspired by the public tribute to Michael Jackson, the New York Times has put together this video on the history of public funerals and viewings.

The introduction articulately states: "Memorials for public figures are equal parts mourning, celebration and spectacle."

Potential Major Changes in the Use of Pain Medicine

2009-07-02T11:12:00.000-07:00

The Diane Rehm show has a great episode today on a recent recommendations to the FDA on a scale-back of the safe dosage of acetaminophen.

It's not directly related to end-of-life issues ... but two painkillers, Percocet and Vicodin, do include acetaminophen, and they are sometimes used in palliative care. And, one of the recommendations made to the FDA was to ban Percocet and Vidodin.

I'm posting the link because it's an excellent hour of radio and an important issue for everyone to stay informed on.

If for no other reason than who hasn't taken two tylenol or two Excedrin when they had a headache? And an interesting tidbit from these recommendations: two pills at once may be too much acetaminophen for your liver to healthfully process.

Yemeni Flight's Lone Survivor

2009-07-02T10:52:00.000-07:00

I am fascinated by the story of the 14-year-old woman who has turned out to be the lone survivor of the recent Yemeni airplane crash.

It's absolutely amazing to me that one, singular person could come out alive while 153 others died.

Of course luck and chance must have played a role in her survival. But I can't help but think of Amanda Ripley's wondeful book, The Unthinkable: Who Survives When Disaster Strikes. In this book, Ripley researches the thought-processes and brain chemistry of people who are able to survive major disasters. I just can't get away from the thought that there must be something outstanding about this young woman.

I wonder what it is about this girl that makes her such a survivor. Her uncle has stated that she had a broken collar bone, had hit her head, had burns to her knees, and still managed to cling to plane wreckage for hours. According to one report, it was 13.5 hours.

Palliative Care Grand Rounds, Volume 1, Issue 6

2009-07-02T10:23:00.000-07:00

This month's edition of Palliative Care Grand Rounds is now up at Tim Cousounis' blog Palliative Care Success.

It offers a great look at what has been happening in the blogosphere this past month regarding end-of-life issues. And he very appropriately begins it within the framework of health-care reform and bioethics discussions ... because isn't that what's on everyone's mind right now?

Please take a few moments to check it out.

Dan Savage on DOMA

2009-06-25T10:22:00.001-07:00

Dan Savage rocked it on Morning Edition today.

He spoke out against President Obama's decision to support the Defense of Marriage Act (DOMA). Savage said, "President Obama should be very angry with candidate Obama. ... Our expectations have not been met. Who raised our expectations? Candidate Obama."

Those expectations were that DOMA would be overturned once Obama was elected. Instead, the Justice Department filed a brief earlier this month defending DOMA.

Why does all this matter? Among other things, marriage rights allow a partner full survivor benefits, the right to decide on issues of care in the hospital, and the simple right to be there at the bedside when their partner is dying. Even power of attorney is often not enough to guarantee visitation or decision-making ability in the hospital for gay and lesbian partners.

As he usually does, Savage laid it out like it just makes sense, and you'd have to be an idiot not to agree with him. He pulls off that angle like nobody else can.

The Costs of Healthcare

2009-06-25T10:04:00.000-07:00

So, I'm a little late to the party on this one ... but this is a great episode of NPR's On Point featuring the author of the much-talked-about New Yorker article on healthcare, "The Cost Conundrum."

Atul Gawande has written about the high cost of health care in the border town of McAllen, Texas. And the article is getting attention in circles as influential as the White House.

McAllen has one of the lowest average household incomes in the nation but also one of the highest average household costs for healthcare. Gawande investigates why and comes up with some pretty ethically shocking conclusions.

There are some interesting discussions about end-of-life care peppered throughout the show. And it's just a fascinating listen for anyone who follows debates about the future of the medical industry.

Here's a link to the actual article. Image from The New Yorker.

Parental Decision Making and Faith Healing

2009-06-24T10:05:00.000-07:00

While I'm on a bioethics thread ... I've been reading up on this case in Oregon.

Parents Carl and Raylene Worthington are being charged with manslaughter in the death of their 15-month-old daughter because they refused to seek modern medical treatment and instead opted for faith healing.

The child had bronchial pneumonia and a blood infection, both of which the Oregon State Medical Examiner's officer have concluded could have been treated with antibiotics.

I think it's always unfortunate when the state and the medical system have to interfere in the decisions of an individual family, but when the life of a child is at stake, sometimes it has to be done. Because, let's think about this, you don't want to interfere because of, first or all, the family's autonomy. Also because the parents should know the children the best and have their best interests at heart. Parents should be, and usually are, their child's greatest advocates.

In the rare cases when the parents are making decision that clearly put the child at great risk, I think it's the responsibility of the state and the medical team to step in on behalf of the minor.

It really doesn't seem fair to subject the child to religious beliefs that risk their life when they're yet too young to decide those issues for themselves.

The Worthington case is even more complicated because the state isn't merely intervening in care; the parents are being brought up on criminal charges after the child's death. Oregon actually has a law that makes it illegal to rely solely on faith healing when you have a sick child who needs medical help.

It will be interesting to watch how this unfolds—to see if the parents are convicted, and also to see if the law is amended at all now that it is facing its first real application.

Here's a great link for further reading on the ethics parental decision making in the medical process, if you're interested.

Doctors and Lethal Injection

2009-06-23T10:36:00.000-07:00

From today's Seattle Times, this article lays out a fascinating ethical dilemma.

It describes the situation faced by Dr. Marc Stern, who formerly headed the medically program for Washington state's prison population. Stern quit his job when directed to oversee an execution.

Stern felt the execution violated his ethical obligation as a physician to "first do no harm." Also, The American Medical Association, according to the article, disapproves of physician participation in lethal injections.

Other medical staff with the Department of Corrections continued to work on the execution that Stern found objectionable, despite Stern directing them not to.

This raises many interesting issues:

Should a medical doctor be involved with an execution?

Should other medical staff be involved with an execution?

Should a doctor work for a prison system if he/she is opposed to execution?

What would a prison system do without medical staff?

How could a lethal injection possibly be administered without some sort of medical supervision?

Was Stern right to try to impose his ethical concerns onto other staff at the DOC?

Was Stern right to quit over the execution?

Yet another example of how murky the world of medical ethics can be.

No dogmas allowed

2009-06-19T10:28:00.000-07:00

Sort of corny but pretty sweet, too. A dog chapel in Vermont, made both for dog owners to grieve the loss of their beloved canine friends and for all of us humans to be able to bring our dogs along with us into the chapel. The chapel was actually inspired by the near-death experience of artist Stephen Huneck.

I love, love, love that visitors can post remembrances of dogs who have passed away on the walls of the chapel. It must be so comforting both to share your memory and read the memories of other dog lovers.

And how clever is that sign out front? No dogmas allowed :)

What happens to your MySpace when you die?

2009-06-12T20:33:00.000-07:00

Seen on the brilliant Fail blog: a questions from Yahoo Answers—very sincerely, I think—asking what happens to your MySpace account when you die. The best answer reads: "It deletes itself. You see when you die a little microchip goes off in your brain and instantly deactivates any accounts you may have. They are inserted a few months after birth, everyone has them." It is indeed a Yahoo Answers Fail.

Violent Death Onscreen

2009-06-08T20:56:00.000-07:00

Christian Sinclair sent me this great article about Mike Doyle, an actor who has died violently on television (or acted out dying violently on television) seven times.

Several things we learn from the article: it's easier to fake die with your eyes open; find a comfortable position to lie in because you might be there for a while; when thinking back on past roles, sometimes it's hard to remember whether you were the murderer or the murdered; and moms don't like this type of work.

Every time Doyle dies onscreen, his mother phones: “She’ll call me and say, ‘I know it’s not real, but I just want to make sure you’re O.K.,’ ” he said. “Not that many mothers have seen their son die over and over.”

Sweet and surreal at the same time.

Blog from a Hospice Patient

2009-06-06T19:41:00.000-07:00

One of my favorite discoveries from this month's Palliative Care Grand Rounds is this blog: Life as a Hospice Patient.

It's a near-daily account of one woman's experiences going through hospice care. Her pain. Her treatment. Her embarassments. Her visitors.

Entries like "Getting harder to breathe," are not for the faint of hear, but it's a great window into the world of hospice, and I think a personal perspective that maybe only blogging could give us.

PCGR Volume 1, Round 5

2009-06-05T21:44:00.000-07:00

This month's Palliative Care Grand Rounds is up at the blog of Angela Morrow.

PCGR is a survey of sorts of what's been happening in the blogosphere regarding death, dying, end-of-life issues, etc. Hopefully, once it's been going on long enough, we'll all start to get the sense that us palliative-care focused bloggers and blog-readers are part of some type of community. In fact, I can see it happening already.

Check out the entry, and check out Angela's blog.

Previous entries of PCGR can be found here. And thanks again to Christian Sinclair for initiating the project!

Departures

2009-06-05T10:40:00.000-07:00

Last week, I had the absolute pleasure of watching the film Departures at the Seattle International Film Festival.

Departures won this year's Academy Award for best foreign film. From Japan, the film tells the story of Masahiro, a young cellist with a Tokyo-based orchestra. When the orchestra is dissolved, he reluctantly gives up his dream of being a professional musician and returns to the small town in which he was raised. There, he stumbles into a job ceremonial preparing dead bodies for funerals. Masahiro finds he has a gift for the work and that he takes a comfort in being able to guide people peacefully and properly through their most difficult times.

The film is at times hysterical, at times gut-wrenching, but it is always full of so much life and love and beauty. The set-up allows for several scenes in which we are given a window into people's lives at their darkest hours. And the director reminds us that some of us handle grief and sorrow by sinking to our lowest behavior, some of us handle it by rising to our best, and a rare special few among us, like Masahiro, are able to take those who are lost and aimless in the midst of grief and bring them back to themselves.

I can't recommend this film enough. Even though its subject is death, it is as full of life as any film I have seen. It's a prime example of the strange dichotomy that sometimes the greatest beauty lies in the darkest corners of our existence.

Alas, Poor Jude Law

2009-06-05T10:16:00.000-07:00

From the world of theater:

Jude Law is currently playing Hamlet on the London stage, and he has requested a real human skull as a prop for the scene in which Hamlet addresses Yorick—Hamlet's former jester whose skull he comes across when speaking to a gravedigger. It's one of the most famous moments in the play. And it seems Law wanted a skull that had actually been populated by a soul, a brain, a mind.

It makes sense to me where his request comes from as an actor. The production company was actually able to track one down through an anatomic-parts supplier in Salt Lake City, Utah. However, due to health codes in London, they will not be able to use the real skull and have to go back to a fake.

But I think, as the director of this play, as soon as this move made such a media firestorm, you'd almost have to pull back and return to a fake skull anyway.

Once word gets out that Law is using a real skull on stage, that's all anyone would be looking at during the speech. It would be completely distracting. Already this hoopla is going to pull away from the moment ... but with an actual human skull up there, audience members would be pulling out binoculars and craining their heads to see how real it looks and whether they can tell the difference between it and any old prop.

And just for your enjoyment and because I'm a huge Shakespeare fan, here's my favorite Hamlet, Laurence Olivier, handling this very scene.

PBR Coffin

2009-06-02T13:03:00.000-07:00

This story was submitted by blog reader Leigh.

Bill Bramanti really loves his Pabst Blue Ribbon ... so much so that he has commissioned a casket that is wrapped with a faux PBR label.

This is my favorite part: To celebrate his purchase, the 67-year-old filled the coffin with ice and used it as a cooler filled with, PBR, of course, and put on a party for his friends. (You can see this in the second photo.)

Well, he's definitely got his own aesthetic, but at least Bramanti is planning for his own death, and he doesn't seem to have any fear of the end, serving up cans of beer in his PBR coffin.

New Compassion & Choices Campaign to Start the Conversation About End-of-Life

2009-05-27T14:30:00.000-07:00

Compassion & Choices is launching a new campaign today aimed at encouraging patients to talk about end-of-life decisions with their doctors. According to C&C, the goal is to empower patients to understand their choices and make informed decisions.

Today, C&C President, Barbara Coombs-Lee has an article about the launch in the Huffington Post. Read the article and spread the word.

As all of you know, I'm a huge proponent of informed decision making in the doctor's office. Patients should know their options and be equipped with all of the tools they need in order to make the best decision for themselves.

Especially with something as important as end-of-life matters, how to proceed should be a conversation between doctor and patient (or between the entire medical team and the patient), and I applaud Compassion & Choices for taking such a proactive step in this matter.

The article includes a link to a "Letter to My Doctor" that you can use to begin this conversation if you are nervous about having it in person. Compassion & Choices is also providing visitation forms that LGBT patients can fill out to help ensure their partners are allowed in when they are hospitalized.

These are awesome resources from an awesome organization.

First Death with Dignity in WA

2009-05-22T10:07:00.001-07:00

Yesterday, Washington state had its first death under our new death with dignity law. It was a 66-year-old woman with stage four pancreatic cancer.

Here is an article about the case from The Seattle Times.

Edwin Schneidman, Pioneer in Suicide Prevention

2009-05-18T22:16:00.000-07:00

All Things Considered had a nice obituary of Edwin Schneidman, a legendary researcher of suicide prevention.

Along with publishing several books, Schneidman founded the Los Angeles Suicide Prevention Center and the American Association of Suicidology.

As the obit points out, Schneidman believed suicidal tendencies could often begin to be untangled by asking two simple questions: "Where do you hurt?" and "How may I help you?"

Schneidman lived to 91. In this audio piece, he shares a quote in which he describes showing up to the ER at the age of 90, disappointed to still be alive. Realize he hadn't died, he sobbed, because he was ready for death.

He also often wrote about enriching life by contemplating death and dying and was a proponent of open dialogue on both topics, arguing that people should be unafraid of death.

What Would Jesus Twitter?

2009-05-17T20:21:00.001-07:00

Christian Sinclair alerted me to this site, which he called a good taste fail. I couldn't have said it better myself.

The site is called Tweeji and is like Twitter, except all the tweets are from dead celebrities—Bettie Page, Shakespeare, and yes, even Jesus Christ himself.

Today, Jesus tweeted, "My day is about to end and I never got to go Jew fishing!?!? I need to buy a planner."

Are you kidding me? Is it just me or is this incredibly tacky?

Other tweets seem more like actual quotes from the famous figures, just abbreviated into tweet-like spelling.

Walt Disney tweeted today, "I believe that entertainment usually fulfills sm vital & normal curiosity 4 every man, woman & child who seeks it."

Would this site be funny if the application was better, or is the whole concept a fail from the start? It's definitely sensationalistic and interesting on that level, but once you get beyond the shock-value of the concept, most of the tweets are either completely straightforward and a little boring or so shocking that they can't help but be offensive.

Check it out. Let me know what you think.

Online Estate Planning

2009-05-15T16:24:00.000-07:00

NPR aired an interesting story this week about the legal battles that can ensue over email accounts, domain names, etc., after a person has passed away.

A text version of the piece points out: "... few people have taken steps to plan for their digital afterlife. It's not yet common for people to include their online information in their wills, [John] Dozier [Jr.] says. And even if they did, and the properties were legally transferred to the beneficiaries, terms-of-service agreements on sites like Gmail and Facebook typically prohibit the use of an account by anyone other than the original owner, he says."

It's undoubtedly something we'll hear more about in the future as the portion of the population that has greater web presence begins to age. But man, it would never have occurred to me to include email passwords in my will.

Lost Season Finale Tonight

2009-05-13T10:25:00.000-07:00

No spoilers here, but I am speculating about what might happen, so if you don't want to read that, you should pass on this entry.

All of you Lost fans out there know it is a complicated show with an active online community. The producers of the show will frequently throw in little details, inside jokes, non-cannon elements, that only the hardcore—you could say obsessive—fans will pick up on. (No dig intended here; I'm one of those obsessive fans.) It's not necessary to understanding the show, so if you don't pick up on it, it doesn't hurt your understanding of the show one bit. But it's fun if you catch it.

One of these jokes is related to the "red shirts" phenomenon. This joke dates back to the original Star Trek series. The show, infamously, only had one extra costume for actors to wear when the crew went out on planetary expeditions. So, it would be Spock, Dr. McCoy, Captain Kirk, and some random dude in a red shirt. When bad things went down and someone died, guess who it was? The guy in the red shirt.

So, producers of Lost will often put the extra who is going to die in a red shirt. Here's the story of one such unfortunate soul.

In a big finale of a show that is definitely not afraid to kill off major characters, viewers are no doubt wondering whether someone will be killed.

Well, several episodes ago, the character Juliette had a wardrobe change, and she's now wearing a red shirt.

It makes me wonder.

Palliative Care Grand Rounds, Volume 1, Issue 4

2009-05-12T10:11:00.000-07:00

If you haven't already, please go check out Palliative Care Grand Rounds, Volume 1, Issue 4 at the Medical Futility blog, run by Thaddeus Pope.

It truly has a wealth of information on what's going on in the blogosphere regarding death, dying, hospice care, palliative care. It's probably more than you can absorb in one read. All the more reason to get started now!

The next PCGR will be hosted by Angela Morrow at About.com : Palliative Care.

We're starting to look like a community. Big props to Christian Sinclair for getting this all started.

Dying Alone

2009-05-12T10:02:00.001-07:00

Thanks to Gail for pointing me toward this story.

A woman in South Carolina passed away and was not discovered for 18 months. The woman is described as a lonely widow who had lost contact with most of the people in her life.

Her dog died of thirst in the same room as her, and even when her home was sold for back taxes, it seems no one visited the property and found her body.

It's terribly sad. I keep trying to think about whether good end-of-life care would have helped her avoid this situation.

But, if you live your life alone, how do you avoid dying alone?

Swine Flu Stigma?

2009-05-12T09:53:00.000-07:00

So, this is interesting. Over the weekend, Washington state had its first death attributed to swine flu, and the family of the deceased is arguing with the official cause of death.

It seems they are worried about a possible stigma attached to the man having died of swine flu. The family is pointing out that he was 5'6" and over 400 pounds and had many health problems. But after autopsy, health officials insist his death was caused by complications from the flu.

The family's claims through me off a bit. I can see there being a stigma attached to having swine flu. It's being treated as a particularly virulent virus and people want to avoid it, so no one wants to be exposed. But is there a stigma to having died of it?

Other diseases that carry or have carried stigmas in the past, let's say AIDS, it seems to me, it was because there was controversy surrounding the activities that could have led people to contract the disease. With AIDS, people are not always comfortable with homosexuality, sometimes drug users can contract it, sexually promiscuous people or people who don't use protection may be at greater risk. But the flu, even the swine flu, is just an airborne illness.

Am I missing something? I don't see the stigma.

Middle Man

2009-05-05T14:11:00.000-07:00

A hilarious clip about the reading of a will from one of my favorite shows, It's Always Sunny in Philadelphia.

There's nothing new here, I just ran across this online and felt like sharing.

I love the sweater Dee wears to her mother's will-reading :)

Not his name

2009-04-29T14:36:00.000-07:00

My mom is visiting the Midwest to help her mother prepare for a move. My grandmother will be downsizing and moving closer to other family, in part because of the fairly recent passing of my grandfather.

One of the big tasks of this move is de-cluttering the house (something that happens to be one of my favorite activities, but that's neither her nor there). One room that simply will not be recreated in my grandmother's new home is an office/den that was strictly used by my grandpa. It's been filled with his paperwork, old work documents, fishing and hunting trophies, old calendars given to him by Hershey Foods—his employer. These things need to be tossed or put into storage, except for maybe the one or two especially sentimental items that my grandma wants to look at on a daily basis.

It's a draining process, I'm sure. But one surprising thing that has come up for my mother: my grandmother won't let her throw away anything that has my grandpa's name on it. And it's not a security issue. Because we're not talking about bills and bank statements. Even old notes and junk mail with printed labels.

When pressed for explanation, grandma says, "We can't throw away his name."

But it's not the actual object with his name. Because my mother is allowed to throw away these things if she takes a Sharpee and blacks out his name. So there's something very specific about the power of his written name that my grandmother doesn't want to see end up in the garbage.

I find this fascinating. Think about all of the times his name ended up in the garbage, on junk mail or whatever, when he was alive. And I'm sure that was no big deal.

I've heard more talk from Midwestern relatives about the importance of protecting your name, and it's the only place I've actually heard someone say, "Your name is all you've got." So I wonder if part of this is regional.

Mostly, I would guess it's just her trying to control whatever she can about death. A way to express her frustration about how unpredictable life can be. Also, she spent quite a few years as his caretaker before he passed. This lets her take care of him again in another way, even though he's gone. It's pretty sweet, even though it's not very effective.

Oprah Cancels Columbine Show

2009-04-21T21:25:00.000-07:00

Yesterday, Oprah cancelled the airing of an already-taped show that was to mark the 10th anniversary of the Columbine shooting.

Her reason: she reviewed the finished show and found it focused too much on the killers.

Clearly, from just the standpoint of informing her viewers, the perpetrators are a large part of the Columbine story. This dilemma of Oprah's brings up an interesting dichotomy that I think much of the media faces whenever there is a tragedy of this sort.

To some extent, you have to investigate the killers or criminals and give them press or attention in order to get answers to "What were they thinking?" and "Why did they do it?" And isn't everyone wondering that when something like Columbine happens?

But then there is this guilt that comes along with the fascination. A self-imposed punishment for giving attention to the people who did wrong. And on top of that, I think, an even greater sense that it's wrong to give them any compassion.

I think these sensations appeal to the smaller part of our nature. What happened was wrong, without a doubt. The killers were responsible, without a doubt. But being curious about them is nothing to be guilty about. And extending compassion their way does not lessen the amount of compassion we have left over for the people they killed.

Compassion and attempts to understand do not mean we condone.

Squirrel Detonation

2009-04-16T13:32:00.000-07:00

I don't know if this is making national news, but Spokane, Washington is having problems with an overrun squirrel problem in their arboretum. To solve it, they're blowing up the squirrels!

The parks department has hired a group called Rodenator, which pipes oxygen and propane into tunnels created by the squirrels. Those tunnels then blow up and collapse, killing the squirrels.

The Humane Societies of both Spokane and Seattle have come out against this method, saying it may not be a pain-free way to kill the creatures.

I used to live in New York; I certainly understand the need to rid yourself of unwanted pests, and I'm not entirely educated on just what damage the squirrels are doing to the Spokane Arboretum ... but I can't get over the idea that blowing them up is excessive behavior.

Cryonics

2009-04-11T21:56:00.000-07:00

This week's episode of This American Life tells the story of a cryonics advocate, Bob, and his attempts to help himself and others cheat death. But the technology isn't quite there to reanimate the deceased, Bob's storage facilities are subpar, and funding proves to be a problem.

The ugliness of the situation snowballs into a complete nightmare and a predictable legal battle.

When you listen to the story, if you think Bob's ethics are a little shaky at the beginning, just wait until you hear some of the stuff he's saying at the end of the piece.

For me, this tale is the ultimate in death avoidance. From beginning to end, everyone involved with Bob and his brand of cryonics shows an amazing inability to accept death. They all seem to think the frozen bodies in Bob's cryogenic chambers are in some sort of half-dead state, and it's as though, they don't really have to let go of their loved ones, or accept their own impending deaths, if they have cryonics to fall back on.

As always with This American Life, it's a fascinating tale, and it's full of lots of murky ethical issues.

Worst Safety Video Ever!

2009-04-10T16:06:00.000-07:00

This is the goriest, least-effective safety video I have ever seen.

It's nothing but a series of escalating tragic events with vague warnings for the need to be vigilant and safe on the job.

Funny in a very dark way. I found the link from a coworker. The person who posted it on YouTube claims to have seen the video in an actual safety training. I hope this isn't actually being used to train.

We know from disaster experts like Amanda Ripley that specificity, to the point that your unconscious mind can picture yourself succeeding in dangerous circumstances, is imperative to succeeding in risky situations. I can't image a video like this does much besides sensationalize and scare.

But in its own way, it sure is entertaining.

Facebook Tribute Page to Television Character

2009-04-07T10:18:00.000-07:00

Either fans or producers of the TV show House MD have developed a Facebook page as a memorial to the character Lawrence Kutner.

I don't watch House, but apparently, Kutner killed himself on last week's episode of the show. The Facebook page includes photos of the character and hand-written notes from his "friends," i.e., other show characters, with their reactions to his death.

It's easy to dismiss this as people going too far for a television character. But, if they're upset about the character's death, I think it's great that they have a place to come together and publicly "grieve" about it. And I've certainly had my share of becoming emotionally invested in characters from television and literature.

That said, I do wish the language was restructured a bit ... just to make it more clear that everyone involved is really making the distinction in their minds that this is a television character. And that, while they may be sad to lose his narrative, they do realize it's not a real-life death.

For example, the page's description reads, "Dr. Kutner was a hard working young doctor with a kind, unassuming, gentle manner. He will be missed by all of us." They couldn't have called him a character? I don't think it would have diminished the page to be honest about what it was.

People become emotionally invested in television characters. There's no shame in that. There's no shame in feeling a little sad when a character dies. And publicly grieving for that character with other fans might be healthy. But let's not get together in a virtual group to pretend that character was a real person who we really knew just because we have new technology that allows for it. That's where this page goes too far, to my mind.

And thanks Christian Sinclair for the tip.

Stars and Stripes

2009-04-05T21:18:00.000-07:00

For the first time in 18 years, the press has taken an officially sanctioned photo of a fallen U.S. soldier returning to American soil in a flag-draped casket.

This is thanks to a change in policy instigated by Defense Secretary Robert Gates and backed up by President Obama.

Photo from The New York Times.

Dying to Live

2009-04-03T10:14:00.001-07:00

I received an email about this amazing-looking documentary.

It's about Ben Mittleman, and also directed by Ben Mittleman, and follows his journey through what starts out as with a leaking heart valve that needs open heart surgery. An athlete an actor, Ben finds weakness of the body difficult to cope with.

But it also snowballs into an ill mother, a lover with lung cancer, relationship difficulties, hepatitis C ... all within the course of one year.

It's called Dying to Live. Film's site here.

Planning for Your Funeral in Advance ... and Personalizing It

2009-04-02T09:52:00.000-07:00

The Today Show has a story about the need to pre-plan your funeral.

Meredith Vieira interviews the authors of Grave Expectations who were inspired by attending several funerals that did not reflect the character of the deceased.

From the small amount I've been involved in funeral planning for other people, I find it's usually done in stressful, emotional circumstances, and you don't have the frame of mind to really think through what would reflect that person's personality.

If you want your funeral to reflect your own style, I think planning it in advance for yourself is a great way to go. Plus, you can really take burden off of loved ones in terms of logistics and finances.

Visit msnbc.com for Breaking News, World News, and News about the Economy

Also, if you watch the piece, I love the idea of the "vid-stone" ... but would it hold up to the elements?

Palliative Care Grand Rounds, Volume 1, Issue 3

2009-04-01T10:19:00.000-07:00

Welcome to volume one, issue 3 of Palliative Care Grand Rounds!

Here you will find an overview of what's been happening in the cyberworld regarding palliative care, death, dying, end-of-life care, and all sorts of related topics for the past month.

Entries in this series are rotating throughout palliative-care-oriented blogs and are hosted on the first Wednesday of each month. Next month's series will be hosted by Thaddeus Pope at Medical Futility on May 6th.

There is a lot here, so if you want to read a bit at a time and come back later to read some more, that might be a good way to approach it. I do realize it looks overwhelming :)

That said, let's jump right in ...

This month, a study was released in JAMA telling us that terminal cancer patients who are self-defined as religious are nearly three times as likely to seek life-sustaining measures near the end, and are also less likely to prepare for death—in terms of advance directives, living wills, healthcare advocates.

Also this month, Washington's Initiative 1000 went into law, legalizing physician assisted suicide. One stipulation of the law is that hospitals and individual practitioners can choose to opt out of the legislation. The has the potential to cause massive confusion. As a Washington-based nurse practitioner, risaden of Risa's Pieces, has an excellent post on his thoughts on this law, what he has encountered related to it, and how it compares to Oregon's law.

Taking a harder look at the risks of skiing without a helmet, and the signs of serious head trauma in the wake of Natasha Richardson's death—a sad reminder that death by falling is the third most common cause of accidental death.

60-Second Psych in Scientific American takes a look at whether the suicide of Nicholas Hughes, the son of Sylvia Plath and Ted Hughes, was due to hereditary causes. Children of mother's who kill themselves are more likely to commit suicide ... but is that correlation or genetics?

If the Rapture occurred, what would happen to your bank account? That's right, the Christian Rapture. Well, Mark Head thinks that in the event of the Rapture, in the midst of God's eternal glory, you will still be worrying about what is happening to your financials down on earth, So, for a $40 fee, he has a service that sets up an email that can be sent to your relatives with your bank account information. (And you can totally trust Mr. Head with your financial information.) "Christians on call" for the site log on to it to keep it going. If no one logs on for three days, it is assumed Rapture has taken place, and the emails are sent out. I guess you'd want to pick your most heathen-y relatives, just to ensure they're left behind to receive the email. How do you start that conversation?

This piece is a real doozy. How you go from normal life and a simple spinout in snowy conditions to freezing to death, or nearly freezing to death. And what it's like to freeze to death. Fascinating. Well-written. From Outside magazine online.

A story about taking care of Sean, a former Fortune 500 company worker with early onset Alzheimer's, from the blog Confessions of a Young Looking Social Worker.

A geropsychiatrist writes about two old goats—one figurative and one literal—both using the same meds to good purpose. Funny!

A touching piece that comes very close to my interests. A medical librarian writes about her mother-in-law's good death from cancer—thanks largely to the help of good hospice care—and the bittersweet satisfaction that brought the family.

The blog Palliative Care Success discusses a NEJM article that shows high-spending regions of the country are more likely to recommend hospitalization for an 85-year-old patient with an exacerbation of end-stage congestive heart failure. They were also three times as likely to admit this patient to intensive care, and 30% less likely to discuss palliative care with the patient and family. The post suggests Advanced Palliative Care Organizations (APCOs) can help reduce the number of people dying in hospitals and reduce the number of days patients spend at the hospital near the end, but APCOs are limited in how many physicians and other professionals they are drawing.

The relationship between palliative care and the church, the spiritual role of palliative care ... but also the palliative care needed by a dying church (in this particular community) are all addressed in this beautiful blog entry written by a former pastor and Tampa-based hospice worker.

Losing a laptop becomes an opportunity to explore advance directives as a metaphor for being prepared for the death of technology with backup and storage.

Fran Johns, one of my favorite bloggers, has a beautiful piece on the therapeutic and restorative qualities of pulling Oxalis. Fran is part of the slow-blogging movement and does not update often, but when she does, it is always something amazing. Be sure to bookmark her site.

At The Mom and Me Journals dot Net, Gail Rae writes about donating some of her mother's items to a garage sale. The need to de-clutter leads her to rid the place of her deceased mother's items as if they are just things, but one special piece, a tiara, needs an important home.

Dethmama finds welcome relief from her work as a hospice nurse in the form of a new puppy named Olive. She has also posted a long-awaited sequel to a great story, Hospice Hitwoman and the C.Y.A., about a family who is anxious to see their loved on pass away, before the right time even.

At the Pallimed blog, Dr. Drew Rosielle discusses a study that shows most people do not understand the actual details of resuscitation, and many would choose to not have chest compressions, shocks IVs through the groin, even though those are sometimes regular parts of resuscitation. Dr. Rosielle also has an excellent post on JAMA's series on palliative care of latinos.

Pride and Prejudice and Zombies: Seth Grahame-Smith has reworked Jane Austen's Pride and Prejudice to include zombie battles. You can find a fantastic (in every sense of the word) excerpt here.

If you want some death at the movies, check out Sunshine Cleaning, an irreverent and touching comedy about two sisters who open an industrial cleaning business—specifically cleaning up after dead people. The film stars Emily Blunt, Amy Adams, and Alan Arkin.

Is it ethical for a wife to use a deceased spouse's sperm for artificial insemination? The Health Monitor at Radiography Schools takes up this issue and contrasts it with other sperm-donor controversies of late.

Is there such a thing as a style for your illness? Dana Jennings writes about getting a buzz cut to develop a tough, "Prison Break"-esque style for his prostate cancer treatent. For him, the haircut is a "visible bulwark against the tide of emasculating side effects caused by the treatment of prostate cancer."

Thanks to all who sent in suggestions! I'm sure there is even more out there I couldn't get to. And if you're interested, here's where you can find issues 1 and 2.

NFL Player Stopped for Traffic Infraction on Way to See Dying Mother-in-Law

2009-03-27T14:12:00.000-07:00

You must watch this video.

The player, Ryan Moats is trying to get himself, his wife, and another family member to the hospital in time to see his mother-in-law before she dies. Clearly, he is not concerned with having run stop signs and red lights; he has bigger issues on his mind.

Now, I understand he has broken traffic laws, and the officer has a right to question him about it, but what reasonable human being wouldn't understand the gravity of the situation? How could he not have waited for Moats to visit his mother-in-law before he wrote the ticket?

I think it's pretty clear from the video that Moats does not care one iota about his offenses. The only compliance he is offering is to get the officer off his back.

And a couple of things are particularly shocking about the officer's behavior to me:

1) he pulls his gun right when he leaves the car

2) he tells Moats that his attitude sucks. I'm sorry officer, whose attitude sucks?

I'm just glad the wife and the other family member were badass enough to ignore the officer and walk into the hospital despite his orders.

Facing Facebook

2009-03-26T10:06:00.001-07:00

We've all had a teacher or two who really inspired us.

For my sister, it was her high school art teacher, Mrs. Saad.

Yesterday, she found out via Facebook that Mrs. Saad had suddenly passed away at a fairly young age.

It occurs to me, before our age of new media, this is probably something my sister would have found out about much further down the road—as gossip through a friend, or at her next school reunion. Now, she is struggling with the tragedy of how this woman's life ended prematurely, and also the immediacy of the news.

I wonder how it will change grieving that the entire community of people who know and knew someone can instantaneously become aware of their passing. Is this healthier, or is this more than we should be expected to handle?

Torture on Television

2009-03-26T09:58:00.000-07:00

Once again on Lost last night we saw that torture works as a means of extracting reliable information.

Experts in information gathering repeatedly tells us that torture is not a way to gather reliable information, and yet TV shows like 24 and Lost continue to show it as a way of finding out the truth.

In last night's episode, the truth that was found out was so outrageous, no one believed it anyway ... but it was actually the truth.

I love Lost, so I'm not turning against the show because of this facet of it, but it does continually annoy me that they insist on glorifying the usefulness of torture.

"Freak Accidents"

2009-03-24T21:45:00.001-07:00

Just wanted to restate something I said in my post last week about Natasha Richardson.

I called her fall a freak accident. While it is accurately an accident and is undoubtedly tragic, calling it "freak" makes it sound more out-of-the-ordinary than is accurate. And as I have written before, falls are the third most common cause of accidental death.

I don't want to be sensationalistic now, do I?

Prostate Cancer Screening

2009-03-21T22:30:00.001-07:00

The New England Journal of Medicine has this study about the effectiveness of prostate cancer screening. Researchers looked at two large groups of men—one group was administered annual prostate cancer screenings, the other group was considered control and was allowed to handle screening however they and their health-care professionals would regardless of the study.

After 7 to 10 years, there was no significant difference between the two groups in terms of deaths from cancer.

I am especially interested in this issue because, back when I worked in bioethics at the University of Washington, prostate cancer screening was one of the primary topics we focused on.

If this issue is new to you, you might wonder why a cancer screening test would need to be studied. Well, it's not entirely clear how effective prostate cancer screening is for several reasons.

To test for prostate cancer, men are screened for a prostate-specific antigen (PSA) in their bloodstream. Sometimes a false positive can be created through the PSA test. Also, prostate cancer can either be fast growing or it can be very slow growing. The fast-growing type obviously needs to be addressed. If a man has the slow-growing type, he may die of something else before the cancer ever becomes an issue for him. In addition, many of the treatments for prostate cancer have major side effects—pain and discomfort but also impotence and incontinence.

Obviously this test can and does save lives. The bottom line is, whether to test for prostate cancer is a complicated decision that should be discussed between patient and doctor. Unfortunately, once a man reaches 50, many doctors just give the PSA test as a regular part of treatment without discussing the pros and cons of it at all.

I hope this study making the news will create more discussion about prostate cancer screening.

Sleeping Beauty

2009-03-21T22:00:00.000-07:00

Dethmama sent me a note about Rosalia Lombardo—an Italian girl who died on December 6, 1920, and was embalmed for preservation. She has been nicknamed Sleeping Beauty because, in many ways, she appears to be just sleeping.

She is in remarkably good condition still, and her corpse is housed in the Capuchin Catacombs in Palermo, which I posted about below.

Just a little more information to add to the thread on strange burial sites that seems to have become the theme for this week.

Economy Hits the Funeral Industry

2009-03-19T10:53:00.000-07:00

The Seattle Times has what I think is a fascinating article today about hard economic times hitting the funeral industry.

People are cutting back on the level of service they set up for deceased loved-ones, ornate details, things like that. Some are hosting receptions at their own homes instead of having catered events.

It makes sense. Why go into debt over a death? I can understand wanting to put on a grand last hurrah for someone you loved, but not to the point that it hurts your bottom line.

Maybe, this economy will help people question the funeral industry more.

There are a lot of unexpected costs associated with burial, funerals, receptions, etc. It can cost a lot more than family and friends anticipate it will. And I don't want to imply that those are necessarily inflated expenses, but sometimes, people are so stressed and emotional, they just sign away without really thinking about whether they want or need to pay for a certain expense. This could be a possible positive fallout of a bad economy.

Security Helmets

2009-03-18T12:05:00.001-07:00

I don't want to write too much about this because I think this is a time during which this family deserves privacy ... but I want to point out how good the human brain is at finding ways to create the myth of our own safety.

Actress Natasha Richardson is in critical condition due to a tragic ski accident on a beginner, bunny hill. Just one of those freak accidents, a terrible, terrible event, and unfortunately, something that happens in life every once in a while.

News reports coming out about this immediately pointed to the fact that she was skiing without a helmet.

I think writers included this fact so readers could feel a false sense of security. You read that and think, "Oh, but I would wear a helmet and therefore, this would never happen to me." But my goodness. I am far from an avid skier, but I do live in the Pacific Northwest where people ski a lot, and nobody skis with a helmet.

Reporters have just thrown in this made up, miscellaneous safety precaution that Ms. Richardson was supposedly ignoring in order to give readers a phony safety blanket.

Religious Patients More Likely to Seek Aggressive, Life-Prolonging Care

2009-03-17T15:03:00.000-07:00

The results of this study may seem somewhat contradictory, but they do not surprise me in the least.

A new study, to be published tomorrow in the Journal of the American Medical Association, reports that, of terminally ill cancer patients, those who were devoutly religious, were almost three times as likely to seek aggressive, life-prolonging care, and they were less likely to do advance care planning—living wills, DNR orders, appointing health care proxies, etc.

You might at first think that the religious would be ready to go on to the afterlife and therefore more comfortable with death and more prepared for it, but some of the anecdotal evidence I have heard from people in the medical field contradicts that supposition. Also, if you remember back to the Terri Schiavo case, it was self-identified religious groups fighting to keep her on life support.

Sometimes, theses issues overlap in ways that don't necessarily equate with common sense.

Neptune Memorial Reef

2009-03-17T14:48:00.001-07:00

A follow up to my post below.

Here's a Fox News report on the Neptune Underwater Reef.

The "reef" is a man-feature. People's cremated remains are placed into the sculpture/reef and will potentially replenish the reef, nourish the fish, etc.

I can see being interested in this as a final resting place if you were an avid scuba diver or loved the ocean. But I don't buy the whole, "giving back to the earth" angle as a primary motivation, which the CEO pushes.

Heck, if you like the idea, more power to you. Personally, it CREEPS ME OUT!

Extraordinary Burial Sites

2009-03-17T14:11:00.000-07:00

I'd be curios if any of these actually appeal to anyone out there.

Mental_floss points us to 8 extraordinary burial sites. I've included photos of just a few:

*The Capuchin Catacombs in Palermo, Italy. Yes, those are preserved, mummified remains.
*The hanging coffins on limestone cliffs in Sagada, Philippines.
*The underwater Neptune Memorial Reef off the coast of Florida.

I get chills just looking at them ... but they are fascinating. And I would be quite curious to visit some of the sites. Especially the hanging coffins in the Philippines.

Thanks to Christian Sinclair for the link!

So what if this is just an excuse to post this video?

2009-03-17T13:48:00.000-07:00

Another slow day at work, which means more YouTube time

Russia has announced it is modernizing and expanding its military, which led a coworker and me to a discussion about how much more open and direct—sometimes even darker—the Russian sensibility can be when dealing with military operations and even death in general.

Some YouTube searching of their military technology led us to this video, which looks to be propaganda in favor of one of their tanks. It's brilliant.

Death isn't just for dead people

2009-03-16T16:28:00.000-07:00

So, a bit of an offbeat post, but it's been a slow day at work, and I have been watching episodes of the live-action Tick series on YouTube.

Here are a couple of clips of the Tick waxing philosophical on death. The first one starts right out and goes until about the 50-second mark. The second clip starts about 35 seconds in.

Dog Funeral from 1921

2009-03-12T22:46:00.000-07:00

Christian Sinclair sent me this great photo of a dog funeral from 1921.

You can see it in more detail, along with a fairly heated discussion about whether money should be spent on a headstone for a dog, at this link.

I'm sure it surprises no one that people are paying tribute to deceased pets. We've talked before about the debate over being buried with your pet.

But it's great to see an actual photograph documenting the interest. I love that it's such a social occasion—several friends have gathered, bringing their dogs along, all to mourn "Buster" together. And I love knowing that the modern American obsession with dogs is at least 90 years old.

Stay of Execution

2009-03-12T22:26:00.000-07:00

The Washington State Supreme Court has issued a stay for the execution of Cal Coburn Brown, who had been scheduled to die by lethal injection at 12:01 a.m. this Friday (tomorrow).

The stay was issued on the grounds that the supreme court would like time for courts to determine whether lethal injection constitutes cruel and unusual punishment. That matter will come before county court in May.

I can't imagine what an emotional roller coaster this situation is for everyone personally involved.

More details on the case and the stay are available at The Seattle Times.

Solace

2009-03-12T16:34:00.000-07:00

Much of our communication is nonverbal.

I'm not going to throw out any percents here ... but I don't think anyone would argue that a lot of times, the way we get a message from Point A to Point B has nothing to do with language.

This film, which was forwarded to me by filmmaker Bill Kersey, is a poignant example of just how powerful silence can be.

The film's official description: " The story of a man, his grief and his guitar is told through music and a lyrical montage of still images."

Both sweet and moving, it's only three minutes long, and definitely worth your time.

Washington State's First Execution in Eight years

2009-03-12T08:48:00.000-07:00

For most of the past six months, my home state has been on the verge of its first execution since 2001.

Two separate executions have been cycling through the legal system. One is the possible execution of Darold Stenson, who was convicted of killing his wife and business partner in 1993. A judge ordered a stay on that execution in early December (for at least 90 days). I'm not sure where it stands right now.

And now, it appears, barring any further appeals, that Cal Coburn Brown will be executed at 12:01 am on Friday—in other words, late tonight, early tomorrow morning.

The immediate prospect of an execution always raises the issue of whether the legal system should be killing people, especially in an area like Washington where it doesn't happen very often.

Here, from the Seattle Times is a pro–death penalty piece and a con–death penalty piece. Anyone else care to add their voice?

Palliative Care Grand Rounds, Volume One, Issue Three ...

2009-03-06T10:44:00.003-08:00

... will be hosted right here, on Wednesday April 1.

If you have tips or ideas for things for me to add—stories, radio programs, articles, blog entries, whatever—on death, dying, end-of-life care, palliative care, anything like that, please forward them along.

You can email them to me at jessica.knapp@gmail.com. Or just drop them into the comments section of any blog entry for this month, and I'll probably get the message that way, too.

And don't forget to check out Palliative Care Grand Rounds, Volume One, Issue Two, currently up at dethmama's blog!

Blogger on vacation!

2009-03-05T19:48:00.000-08:00

Hi guys.

Expect light posting between now and March 12th or so because I am on vacation. I may still log on here and there, but I definitely will not be up to my normal volume.

Cherry Blossoms

2009-03-03T20:38:00.000-08:00

I was looking through my archives, and I don't think I ever posted about this film.

So ... I'm a bit of a sentimental sap, but I cry watching this trailer.

It's playing in Seattle for just a week, and I'm going to be out of town for six of those days. I'm hoping I can figure out how to get there that last day.

I love the conflicting views of what makes a satisfying life—the hedonistic husband who is happy with his daily pleasure of having a loving relationship with his wife versus the epicurean wife who wants to have the big, grand adventure of seeing Mt. Fuji. The music. The acting. You expect the husband to be the one to go, and then it's the wife. That moment when he's on the bed, and he has laid her clothes out next to him. And then he packs up her clothes so he can take "her" to Mt. Fuji with him finally.

Just beautiful ...

Visit dethmama.blogspot.com

2009-03-03T20:18:00.000-08:00

You should check out dethmama's blog right now for two reasons.

1) She has a great story about her first experience with "the unexplained" in the passing of a patient.

2) On March 4, she is hosting the second round of Palliative Care Grand Rounds—a monthly blog carnival highlighting what's out there in cyberspace that covers issues of hospice care, death, dying, grieving, caregiving, etc. It's your best opportunity this month to see what the cyber community is writing about these topics. And dethmama is a gripping writer, so I'm sure her turn at the rounds is something not to be missed.

Death with Dignity Specifics Adopted ... and Not Adopted

2009-03-03T11:33:00.001-08:00

Another article on the difficulties of implementing Washington's new death with dignity law, again, it is specifically focused on who will be choosing to opt out of the law and who will be choosing to administer it. (Individual pharmacists, doctors, hospitals, etc., are allowed to choose under the legislation.)

It will be interesting to see how all of this plays out.

One example: if you read this article closely, you will note that, while the University of Washington has not decided to opt out of implementing the law, the director of palliative care consult services at the UW does not plan to prescribe any lethal medications to his patients for now. He will instead refer them to Compassion & Choices of Washington.

Contradictions like these are sure to run throughout the system. I just hope there isn't too much confusion. We all know how confusing the healthcare system already is.

Must Read After My Death

2009-03-03T10:33:00.000-08:00

After his grandmother's death, Filmmaker Morgan Dews discovered a mass of audio recordings, home movies, photographs, and written journals detailing the turbulent lives of his grandmother's family in the 1960s. Using these materials, Dews has created a movie that the film's site says "affords fly-on-the-wall access to one family's struggles amid an America on the verge of dramatic transformation."

Thanks to Christian Sinclair for the link. (You're practically filling my blog this week!)

Most unusual are dictaphone recordings left by Dews' grandparents in which they offer shockingly honest comments about the state of their marriage and family. You can see some of that in the YouTube clip.

Also, you don't have to wait for this film to hit theaters or come to rental. If you're interested in Must Read After My Death, simply go to the film's website, and you can purchase a copy for play on your computer for only $2.99. Pretty neat.

I plan to watch it, although I haven't gotten around to it yet. And fair warning, I'm notoriously bad at actually watching movies that I plan to watch.

When it rains, it pours ...

2009-02-27T13:44:00.000-08:00

Another piece of good news from our current administration.

From The New York Times:

"WASHINGTON — The Obama administration moved on Friday to undo a last-minute Bush administration rule granting broad protections to health workers who refuse to take part in abortions or provide other health care that goes against their consciences."

The article references issues related to women's rights and reproductive choice, but as I blogged earlier this week, Barbara Coombs Lee has been very vocal in getting the word out that this law would also affect people's access to death with dignity.

And just like that, I'm a Robert Gates fan ...

2009-02-26T21:02:00.001-08:00

For me, proof that even in the most stressful times, life is still full of happy surprises.

Defense Secretary Robert Gates has reversed the policy that forbid press coverage of flag-draped caskets carrying the remains of fallen U.S. soldiers coming into Dover Air Force Base in Delaware.

The decision will now be left up to individual families whether to allow media access to each homecoming.

If draping a flag over the casket is not meant to be a visual symbol, then why do it? And if it is a visual symbol, why are we afraid for people to see it? And if the family of the fallen wants to share it with the world, why shouldn't they be able to as part of their efforts to fully honor their family member?

The policy was first put in place in 1991 by George H.W. Bush, and this time around has been in effect since 2001. (I believe President Clinton put a hold on the regulation when he was in office, but I'll have to double check on that.)

Anyway, as they say on one of my favorite blogs, Shakespeare's Sister, taking one little teaspoon out of the sea of injustice.

Photo from ABC News.

Practical Advice on Handling Death

2009-02-25T11:19:00.000-08:00

As I've said many times before, Diane Rehm is my favorite, favorite radio host.

On Monday of this week, she interviewed NY Times columnist Jane Brody who has a new book called Jane Brody's Guide to the Great Beyond: A Practical Primer to Help You and Your Loved Ones Prepare Medically, Legally, and Emotionally for the End of Life.

Self-aggrandizing, super-wordy titled aside, it sounds like a very practical, down-to-earth write-up of some of the small details many of us are not prepared to deal with. She focuses on both what the dying person and the loved ones of the dying person should do. Things like a living will, of course, but also assigning a health-care proxy, someone to advocate for you and your wishes.

She also advocates bringing death back into the regular conversation of life and not separating it out into something that strictly happens in a hospital, removed from everything else. And you all know I'm in favor of that.

Here's a link to the interview. Here's a link to the book.

Death Penalty Being Done in By Economy?

2009-02-25T11:09:00.000-08:00

An interesting article from The New York Times today about the costs of the death penalty.

It seems abolishing the death penalty is becoming increasingly popular during these hard economic times as a cost-cutting measure.

We will have to watch to see if any of these arguments come up during the two executions Washington state has scheduled for March of this year.

Death with Dignity Specifics Adopted

2009-02-24T11:09:00.000-08:00

Washington state has adopted the specific guidelines that it will use to implement its new death with dignity law. The Seattle PI has this article about the guidelines.

Unfortunately, the article is not super informative and is actually pretty vague and confusing. (I think it tries to cover too much in one piece instead of just focusing on the most recent developments.) But I'm going to link to it anyway since it's one of the first mainstream pieces written about death with dignity in our area in a while.

I'm hoping, as the deadline approaches, some better, more specific information will come out.

Suze Orman Will & Trust Kit—Free

2009-02-24T10:08:00.001-08:00

Right now, Suze Orman is providing free access to her online will and trust kit.

Go to this link and type in the password PeopleFirst.

I haven't used the service myself, so I dont' know how user-friendly it is. But I caught the last few minutes of her show the other night during which she was discussing this offer, and I thought I should pass it along.

I assume the offer is good least until her next episode airs (Saturday night). But if you're interested in checking it out, I'd make a quick move.

And if you do use the service, I'd be curious to know how it goes.

The Conscience Rule

2009-02-23T10:52:00.000-08:00

Barbara Coombs Lee of Compassion & Choices has recently been blogging at Huffington Post about the "conscience" rule.

This law went into effect on January 19 it allows medical workers to refuse to participate in care that goes against their moral beliefs. Obviously, one of the areas this can and will affect is death with dignity. And we already know some facilities in Washington state have decided not to participate in the newly passed law.

Particularly troublesome for me would be any physicians who would refuse treatment but also would not tell patients that the option is available for them. The post by Barbara Coombs Lee says most physicians who object to a treatment would let a patient know about a treatment but some would not—no figures are given though.

Whatever side you come down on, it is an important issue that is getting lost in the midst of economic worries. Check out the blog or Google the topic—but Google "conscience rule HHS," or you won't get decent results.

2009-02-23T10:38:00.000-08:00

Another great link from Christian Sinclair. I love this video for its simple honesty. It reminds me of this article from Scientific American that talked about consciousness after death.

Many of us ponder death in a way that assumes we will have thoughts and sensations after it happens, but when it comes, both the article and the video say, we will simply stop, and we will not have consciousness to be aware that we have stopped. Therefore, there is no reason to fear our end.

In his post on the video, Sinclair compares its tone to that of a children's book. I could not have said it better myself. There is a simple, instructive narrative. A heartwarming feel, despite the hard subject. The narrator sounds like he wants to take care of us. To walk us gently through this harsh truth.

Give it a watch. I'm curious to know what other people think. Also, nothing really happens until the 40-second mark, so if you're a techy-generation, impatient sort, you'll want to zoom ahead.

Death Cake

2009-02-23T10:26:00.000-08:00

Man, oh man. What a way to say Happy Birthday! Christian Sinclair sent this link to me—he's been sending all kinds of great links lately. Thank you, Christian!

From the very funny blog cakewrecks.blogspot.com.