Having “The Conversation” about End of Life Healthcare Planning

The Nugget, Sisters, Oregon – October 15, 2014

Having “The Conversation”

By Diane Goble

Ever since Ben Franklin warned us, “If you fail to plan, you are planning to fail,” we’ve been diligently planning for everything — college, career path, marriage, children, home buying, vacations, retirement — everything, that is except our inevitable end of life. We don’t want to think about that so we tend to ignore it or postpone dealing with it, often until it’s too late. We live in the state of denial that keeps us oblivious to the unthinkable fact that this day could be our last on earth.

Hopefully that’s not true for you this day, but statistically, in this country, 1 person dies every 3 seconds, approximately 6800 of us every day, 2,468,435 every year. Most people die from health-related conditions, including (in order) heart disease, cancer, chronic respiratory diseases (COPD) and stroke. Accidents are next down the list. All of these are, to some degree, preventable, treatable, manageable, mitigated by medical care and healthy lifestyle changes, and most of us will survive to live the life we planned to a ripe old age.

And that’s part of the problem. Health care has improved, we’re making progress with many cancers, we’ve recognized the problem of obesity and we’re eating healthier and exercising more so we’re living longer but we’re getting diseases now that people didn’t use to get because they died at earlier ages — Alzheimer’s Disease, in particular, but also emphysema, COPD, Parkinson’s Disease, and diabetes. And with the aging Boomer population, we wonder will there be rationing of medical services.

The health care system has us focused on treatments that almost kill us in order to make us better so we can live longer and get more diseases for them to treat. At the same time there are more people in need of care, there are also fewer doctors and medical services are stretched thin.

And within this maelstrom of activity is the elephant in the room. At some point, we are all going to die — but no one wants to admit it or talk about it and certainly know one wants to plan for it. We always think there will be more time.

This is a quote from this correspondent’s soon to be released book on amazon.com, Beyond the Veil: Our Journey Home, from a woman named Kathy who shared her experience of not planning ahead:

While we had gradually acknowledged to each other that he might not make it, we’d never really accepted it or talked about what it meant. I always thought we’d have a period of time when he was in hospice care when we would talk more and say our goodbyes. While I, and my kids, said lots of goodbyes and I love yous while he was in a coma, he was never able to communicate with us again. I still replay those last few days over and over and wonder how we didn’t know he was so close to the end and wonder if he knew.

There is a lesson in this: to say the things we want to say while we can – and it illustrates why it is so important to plan for the end of our lives, not just for our selves, but for our loved ones as well. We won’t know how we are going to die, where we will be when it happens, who will be with us or if we will be alone, but we can make our choices known about how we want to be treated at that crucial time, which will guide our loved ones to follow our wishes.

We do have some options and they are more likely to be honored if we have discussed them with our family members and doctors, appointed a healthcare representative who supports our wishes through our Advance Healthcare Directive so physicians will know what we want and don’t want if it comes down to that. The biggest hurdle is sitting down to have the conversation.

Realize that this is not a one-time conversation. It may occur in bits and pieces — a question at the dinner table, a comment during a TV program or news story, a shared article from a magazine, a book, a website, a post on Facebook. Over time and with new information or health concerns, you may change your mind several times.

You may have a conversation with your doctor or a clergy member that provides some new insight or clarifies your values. After seeing what another family went through, you may decide you do or don’t want that to happen to you. Visiting a friend in hospice care may change you mind about how soon you would want to bring hospice services into your life or the life of a family member. Advance Healthcare Directives are changeable and should be reviewed every 5 years or as you health changes.

No matter how old you are — and perhaps this is something everyone should do when they first get their driver’s license because those are extremely vulnerable years for accidents — no matter what your health status is, the time to have these important conversations is when you are healthy and mentally competent to make decisions. By the time you are in an ambulance, in the ER, or on your deathbed, it is too late. Leaving it to your distraught family members to decide what you would want during dire circumstances is setting them up for unending grief and trauma over whether they did they right thing — no matter what they did or didn’t do.

Fortunately, right here in Sisters, there are several people, including Kelsey Collins, Sue Stafford, myself and others, who are available to help people sort through the information about Medicare, home health care, palliative care, hospice services, Advance Healthcare Directives, POLST and Oregon’s Death with Dignity Act. Talk to your doctor, talk to your spiritual adviser and by all means, talk with your family about your last wishes — then you don’t have to think about it anymore!

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A Peaceful Death with Dignity

I’d like to express my appreciation to Brittany Maynard for going public with her decision to exercise her Death with Dignity option in Oregon because it will bring this conversation to the family dinner table where it belongs. Of course I’m sad she has this terrible condition, but if she can make something positive out of a bad situation, which she is by raising awareness, it gives hope to many people who want the same thing– if my death is inevitable, let it be peaceful and on my own terms.

This is what I encourage people to do on a daily basis through my writings and “Having The Conversation over Coffee and Cake” gatherings. I don’t encourage Death with Dignity, but I’m not afraid to address it as an option and provide resources, such as Compassion & Choices, if people want to consider it. This is a truly personal decision that should be between a terminally ill patient and those in his or her inner circle and it’s a shame the Maynard family has to be exposed to the vitriol that permeates Internet over their personal decision to allow Brittany to have a peaceful death with dignity. It’s as if  everybody suddenly noticed there’s an elephant in the room.

Those among us who think we have a right to an opinion about how any person decides he or she wants his/her death to be should be thinking about how they want the end of their lives to be, not someone they don’t even know. If, for whatever reason you think, having control over one’s own death at the end of life, is wrong then do it your way, whatever that is – and let me do it my way. Don’t force your views on me because you think you have all the right answers and I won’t interfere with your decisions about how you choose to experience your last days. And I’m referring here to people who have been given 6 months or less to survive a terminal illness, are in intractable pain or unbearable agony or suffering, and choose not to prolong their life.

That choice is still limited by the ability to self-administer the medication and therein lies the crux of the problem. If the person waits too long and loses decision-making abilities, or there is a sudden change in health that precludes swallowing or self-administering the medication, or if the person makes the request too late for all the paperwork to be completed, there are complications. This is where the law comes in. We can’t have people recklessly giving vulnerable people life-ending medications, or physicians or insurance companies or the government deciding when life no longer has value.

The law that was passed in Oregon takes into account the legal aspects of the issue to the extent that we can protect the vulnerable and protect physicians, hospice workers, pharmacists and families, from prosecution for helping a dying person carry out their wishes for a peaceful ending to their physical existence. This law has stood the test of time with no slippery slope or mass extinction for 17 years and is the basis for the laws passed in Washington, Vermont, and pending a vote in several other states.

Studies among physicians reveal a majority of physicians would refuse treatment and consider Death with Dignity for themselves, but they would suggest continuing treatments to their patients. They have the hypocrisy to claim that an oath written 2500 years ago by people who believed the earth was flat, and gods and goddesses ruled over humanity, told them to do no harm and give no poison. What really is the harm if the person is dying and is in considerable pain?

Which leads us to consider religious views that claim God said this or that, or a Jesus or a Mohammed said this or that, and believe that their holy book or their dogma is the one and only truth – and that it applies to the rest of us. And many people don’t believe… that there is even a God or a Jesus or a Mohammed to have a say so in the matter. Then we have many ethical atheists who think we only have one life and have no right to end it on our own terms.

We live in a world where millions of people die every day, often sick, hungry, dehydrated, neglected or savagely beaten, enslaved, decapitated, electrocuted, eviscerated, drowned, bombed, burned alive, as if they were meaningless cockroaches. But suddenly we become concerned and know what’s best for some poor person who has been suffering terribly with some dreadful disease or condition, and only asks for a peaceful death with dignity in the privacy of their own bedrooms, surrounded by their loved ones.

I hope Brittany Maynard’s plight will be an awakening to all you who have doubts about what is the right thing to for you in a situation like she is facing and begin to see that death is a sacred journey into whatever comes next. We will all go through it, we need to recognize that it is a graduation, not the end of our journey.

The message from my near-death experience is that We Don’t Die! Death of the body is not the end of life – life goes on and there is so much more to look forward to beyond the veil of illusion.

Peace & Joy!

Diane

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Sitting in the Lotus Blossom by Diane Goble – October Special 50% off

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Reincarnation and the Evolution of Consciousness (2013) – 16,000 words – $1.99

Author reading Chapter “The Challenge of Being Fully Human

Author on BlogTalkRadio with Pamela Edmunds’ Bridge Between Two Worlds – 2/12/14

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Author reading Chapter “End of Life Conversations

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• • • • • • •

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Vocals by Diane Goble • Music by Shapeshifter

Sample and donwloads available by clicking on links below

happinessCDHappiness Journey (download) – $1.99

lotusmeditationLotus Meditation (download) – $1.99

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Planning Your Assisted-Suicide

I live in Oregon so I can legally request the

Death With Dignity option

at the time I deem appropriate if I choose, so I’ve thought about what medical treatments and interventions I would or wouldn’t accept and how I would want to die if this or that happens to my body and/or mind, whenever it happens.

I’ve been involved with this issue long enough (see article)– I was a hospice volunteer off and on for over 20 years, I’ve sat with numerous people and their families as they lay dying, I’ve been a caregiver and a counselor to the dying, I had a near-death experience 40 years ago (see article)– and I understand more about death and dying than most people who try not to think about it at all.

Most folks have opinions related to self-preservation, love of family and their life, or religious dogma, but a narrow perspective of the whole issue. So I’m just going to think out loud here to give others some food for thought… with the caveat that you continue this conversation with someone immediately after reading this and get to work on your own Advanced Healthcare Directive.

I’m 70+ so there’s that. Having seen first hand and studied what happens to the body and the mind of the majority of people as they age, I acknowledge my personal limits. Knowing my body and what I’ve done to it and for it, I’m hoping to live healthy to at least 75 but no longer than 80. Closer to 75, more likely. Beyond 80 things seem to fall apart more rapidly and sitting in front of a TV all day in an assisted living home with a bunch of other half comatose people is not something I could take for more than a minute. Lying in a  hospital bed staring at the ceiling with no hope of ever getting up again would be intolerable.

Now I know there are some 90-year olds still driving and playing golf or milking the cows and tilling the fields,  but that’s not me. There are also some 60-year old, overweight couch potatoes, who can hardly walk from the couch to the refrigerator any more.They’re on multiple medications with multiple side effects and are mostly miserable most of the time.

One’s past habits and lifestyle have a lot to say about how fit we will be in our old age, and we should be aware of our genes and our base lines so we can keep track of our physical health as we age. If you’re 40 and have diabetes, you’re not likely to make it to experience much of old age. If you haven’t cared about your health during your life, you’re not likely to have a healthy older age.

Of course one can always get hit by a bus or have a heart attack or get shot by a wacko on his own suicide mission. Personally if I’m too far gone and it would take too much or too long to restore me to a reasonable state of health, I would opt not to be resuscitated in the first place.

Certainly cracking open my rib cage, cutting off any limbs or hooking my body up to artificial life support are completely off the table. I want not to live without full use of my limbs or cognitive processes so don’t even think about it. If my heart stops, let me be. If I come back on my own, this time, I’ll talk about it. If my mind starts to disappear, you can bet I’ll be working on my suicide plan, physician-assisted or not, before I forget who my loved ones are.

So you have this pain or these symptoms you’ve been ignoring but it’s suddenly gotten worse and you can’t do things you used to be able to do so you finally go to a doctor and they run a bunch of tests and tell you that you have cancer of the blahblah and they’re going to have to take out your blahblah and then you’ll have to have radiation and chemo and then maybe you’ll have a few good months left but every case is different and they just know you’re going to beat this so here, sign these papers and let’s get started.

And you go… WTF? Because you never thought about it before, never allowed yourself to think it might happen to you or someone you love. You didn’t hear a word the doctor said after “cancer.” Your mind went blank and you felt like the elevator just dropped 20 floors in a second.

You are now spinning out of control but your doctor has moved on to the next patient to give him or her the same devastating news and you’re left to gather your wits and find your way home to tell your loved ones… but the only word that comes out of your mouth is… cancer or brain tumor or kidney failure or multiple sclerosis. Suddenly you’re a dead man walking.

You’ve never thought about it before? Never asked anyone what their thoughts are? Never asked someone who is dying what they think about? Would you want everything done? Do you even know what “everything” means? How much of you abilities are you wiling to do without just to see the next football game on TV?

You suddenly black out and wake up hooked up to machines in an ICU, paralyzed so you don’t try to rip out the tubes and  lines, surrounded by strangers with masks on looking down at you and one of them says sprightly, “Welcome back, Mr. Jones. We thought we’d lost you.”

And you’re thinking, “OMG, I was having this wonderful out-of-body experience. I was surrounded by loving beings of light and you brought me back to this? I’ll kill everyone of you!” But you can’t speak, you can’t move. Those people out there think you’re not aware, but you’re aware of everything, you just can’t do anything about it.

You’re wishing you had written that Advanced Healthcare Directive indicating you wanted no extraordinary measures to keep you alive if you were in this unfathomable condition. Unless you have a few lucid moments to state otherwise or can at least blink your eyes if asked, it is now beyond your control. You could end up a living, breathing vegetable for years.

If one is born disabled or becomes disabled through accident or illness, there is a whole added dimension to thoughts about one’s death. Depending on how dependent you are on others for care and whether you are able to communicate or are even aware of what’s happening, decisions are difficult, riddled with guilt and fear, no one ever sure they did the right thing. If you could convey your wishes, what would they be?

Assisted dying is not an option under the current laws unless you can self-administer. It has been tested by brave people with ALS and MS in the U.S. and foreign courts but euthanasia, which allows a physician to administer a life-ending drug to a person who is unable to self-administer because of their disability, is considered murder and many people fear that is opening assisted dying up to a slippery slope that could lead to the wholesale killing of the most vulnerable among us– the elderly, the disabled, the mentally ill, the poor.

Instead of showing compassion for those who are wrestling with these very personal decisions, some groups of religious protestors and bio-ethicists use fear and scare tactics, dredging up images from the Holocaust and other genocides, or hellfire and eternal damnation, to keep everyone from having control of how they end their own lives. These moral absolutists feel they are right and everyone else is wrong, and they have to protect us wayward relativists from ourselves as if we had no values. We do, just not the same as theirs.

I value human life as part of our eternal spiritual journey, I just don’t believe in the sanctity of life as the right to lifers do. Theirs is a religion based on fear and a judgmental god. I believe our Free Will gives us the right to determine when the quality of our life has fallen below our level of tolerance; that we should have the right to decide when it’s our time to die, and be able to ask our doctor to help us by giving us a prescription that will allow us to chose the time and circumstances of our own death.

Physicians, pharmacists and hospitals who provide a public benefit to a diverse society cannot impose their personal religious beliefs or moral values on patients at the end of their lives any more than at any other time in their lives. They work for us, we hire them… they are not the boss of us!

The alternative, if one is able, may be to blow your brains out or jump off a bridge or throw yourself in front of a train. What a mess! How much more peaceful and spiritual to take a pill and just go to sleep. Would you rather your family watch you suffer or allow you to die in peace? How much better for your family to be by your side instead of you having to go off like an animal to die alone.

A good way to count oneself down is to make a list of 100 things you do every day and cross items off as you can’t do them anymore until you’re down to the last 5 or 10 or 20, wherever you draw the line, then call your doctor for your prescription, pick it up when you are ready, gather your family together to say your goodbyes and have a final toast to your good death and peaceful journey home.

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National Healthcare Decisions Day – April 16th

Planning a vacation is fun.

Planning a wedding is exciting.

Planning a meeting is important.

Planning for your future healthcare is critical.

Now that your income taxes are behind you,

April 16th

National Healthcare Decisions Day

is a reminder to revisit your Advance Healthcare Directive or finally fill one out to assure that your wishes for end of life care are carried out when needed. This is not just for seniors or people with a terminal illness, anyone over 18 needs to have an Advance Healthcare Directive in place.

On this day a coalition of more than 100 national organizations mobilizes to talk to as many Americans as possible about getting their future healthcare wishes written down, and expressing those wishes to their loved ones and healthcare providers. That means making sure you have an advance directive, which includes a living will, describing treatment you want and don’t want, and a durable power of attorney designating the person who will speak for you until you are unable to do so for yourself.

As much as we would like to hope all will go according to plan, the circumstances of our death may be completely out of our control. An unexpected rupture, a tragic accident, a sudden heart attack, a chunk of food gets stuck in our windpipe. We are suddenly at the mercy of other people, often strangers, making life or death decisions about us. If you have talked to your doctor, and filled out and registered a POLST (Physicians Orders for Life Sustaining Treatment), it will help avoid unwanted invasive, often futile, life-saving procedures in an ambulance or emergency room.

If you haven’t shared your wishes about resuscitation, hydration, blood transfusions, antibiotics, pacemakers, stents, amputations, being kept alive on a ventilator, your family members are going to be asked to make those decisions without knowing what you really want. If you wake up, you may not like their choices. If talking about death makes you uncomfortable, search out a Death Cafe. Have tea or a pot luck dinner, and conversation about death and dying.

Whether you want everything done or nothing done or what your limits are, if you don’t designate a healthcare representative and discuss your wishes, and fill out an advance directive ahead of any life-threatening event, you have no control over what will be done to your body while you are unconscious or what your family will be going through trying to make decisions about what you would have wanted or not wanted.

Medical personnel are well-intentioned, but well-trained to do certain medical protocols by rote. They’re not going to stop to ask whether you want to be resuscitated or kept on a ventilator for an indeterminate amount of time. If your family doesn’t know to speak up on your behalf and make your wishes known, you become a medical procedure.

Studies have shown that families who face these tragedies after having had “The Conversation” with their loved one are less traumatized after losing their loved one than those who never had any discussions about what their loved one wanted in a life or death situation.

For your sake and for your family’s peace of mind, make this April 16th the day you sit down with your family and talk about future healthcare decisions for all members.

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How do you make end of life healthcare decisions?

Of a certain age…

by Diane Goble, Columnist, The Nugget News, April 16, 2014

My best friend just had her second mastectomy last week. In the last two years, she’s had her gall bladder removed, a lumpectomy, a mastectomy and now this one. She says the good news is that she’s lost 20 pounds and can see her toes again!

She has several messages on her cell phone asking her to call another oncologist for follow- up. She’s procrastinating. “It’s not in my lymph nodes so I’m not going for radiation or chemo,” she says. “I’m done with the medical stuff.” She insists she’s going to eat better, exercise more, take up yoga and meditation, and try to be as healthy as possible until she dies. She’s contemplating an artistic tattoo to obscure her now breastless chest.

That’s the rub. You can go through all the treatments and deal with all the side effects of them– sick as a dog and wanting to die most of the time. You maybe get a few good months and then it comes back with a vengeance and you die anyway. The outcome is the same. The difference is the quality of life in between.

This doesn’t have any thing to do with age. My friend is in her 60s, five years younger than I am. It can happen to us at any time in our lives. We have jobs to get to, children to raise, relationships to deal with, bills to pay, retirement to plan for, and then suddenly we have to make these decisions about what we want and don’t want because we are diagnosed with a serious illness or have a life-threatening accident.

I had a stage IV melanoma a while back. Had the Moh’s surgery, no problems, no lymph node involvement. That follow-up oncologist wanted to do radiation and possibly chemo, but I said no thanks. I’ve been in remission for almost 8 years. That doesn’t mean it won’t still come back. One or two spots I’d probably have them removed but that with a vengeance thing not so much. I’ll start planning for the end of my days.

I don’t have a problem with dying. I did that once. Drowned. It was a fantastic journey home and back again. I expect it to be the same the next time, only without the back again, so I look forward to moving on to what comes next… because I know there’s a next. Of course I’ll miss my family and friends but I know I’ll see them again soon.

My concern is more about what will happen to me while I’m still in a body. I refuse to put up with Alzheimer’s. Any inkling of that and I’m making my going away party plans before I forget how! I’ve filled out my Advance Healthcare Directive and appointed a non-family member as my healthcare representative so my children don’t have to make any decisions. They don’t want to talk about it so I sent them their copies and included a video of me telling them my decisions about what I want and don’t want. I’d opt for a heart attack over a prolonged illness, but if it were an illness, I’d be working on the paperwork process for physician aid-in-dying the moment I got that 6 months to live diagnosis then I’d keep working my Bucket List!

So how does one decide what they want at the end of their life? It has to be based on one’s own beliefs and values, not forced on you by someone else’s biases. Talk to your family, your doctor, your spiritual advisor, search your soul, search the Internet… meditate, pray, talk to God or a tree. Educate yourself about the process. There are some good videos out these days about death and dying– “Consider the Conversation,” “How to Die in Oregon,” “The Day I Died: The mind, the brain, and near-death experiences.” The more you know, the better decisions you can make about your own healthcare at the end of life.

April 16th is National Healthcare Decisions Day… think about it!

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What if death is… ?

Death is always a loss no matter how you look at it and it doesn’t mean there won’t be grief, but what if…?

  • What if dying is actually a wonderful, exciting experience as near-death experiencers have described?
  • What if dying is an opportunity to celebrate the end of a wonderful human experience and a joyous return to our spiritual home and family?
  • What if death is our graduation from the University of Life on Earth and we go on to have other amazing experiences exploring consciousness at higher levels, being co-creators with God?
  • What if all those who have transitioned before us are there to greet us, and those we leave behind join us again almost before we know it because there is no time?
  • What if we exist in a multi-dimensional universe in many different forms in many different frequencies of endless possibilities?
  • What if consciousness doesn’t arise from matter, but creates matter?
  • What if our True Nature is continuous and our human lifetimes are breathing spaces along our eternal journey?
  • What if our human lives are not completely predestined and we have the free will to choose to break the cycle of death and rebirth, and move into higher consciousness and higher dimensions?
  • What if we can accelerate our progress by practicing the art of conscious dying during each human lifetime we experience?
  • What if we make the spiritual connection in a human lifetime and go directly into the Light at transition, thereby propelling our soul into the next dimension?

How wonderful would that be?

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Excepted from new book by Diane Goble

Stepping into the Light

Reframing death from a Near-Death Experience perspective

(due out in June 2014)

Vote YES for Death with Dignity laws

Please watch this video and vote with your heart for what you know is the right thing to do…

Vote YES for physician-assisted dying when it comes up in your state before another family has to suffer like this family did, still is, will always. For Nattie’s sake, allow all of us the right to make the choice depending on our own circumstances.

 

Reframing Death for the Death with Dignity debate

As I listened to the public testimony at the hearing before the Connecticut legislature last week on HB5326 that would allow doctors to prescribe life-ending drugs to the terminally ill, what stuck me about the people testifying, whether for or against, was an underlying fear of death.

Some who are opposed to physician-assisted dying cover up their fears by proclaiming that human life, no matter what condition one’s body is in nor how ready to let go one is, is worth living and should not be ended prematurely.

Some religious speakers insist their God decides when it is time for us to die and we have no right to play God or that this is an act of suicide which is a sin– conjuring up images of burning in hell for eternity as punishment.

Many of those in favor of a law with similar safeguards and restrictions to Oregon’s Death with Dignity Act, talked about frightening experiences and fearful anxiety associated with the deaths of their loved ones that they felt could have been reduced if there were such a law and their person could have died peacefully at home in their own bed surrounded by family.

That’s all people are asking is to be able to die in peace, on their own terms, not filled with fear, not strapped to machines surrounded by strangers, not in agonizing pain for days or weeks before the body shuts down… and if the circumstances of their deaths are such that a medication would ease their pain and allow them to continue their dying process in peace if that is their expressed desire, then how can we have a law that denies it because some other people who aren’t yet dying are afraid of death, afraid of a slippery slope, afraid of genocide, afraid of impending doom?

Then there’s the fear of being charged with murder if out of compassion for a person’s suffering a loved one helps a person by administering a lethal medication. Families are forced to live with the fear of watching their loved one dying in agony knowing there is nothing they can do to relieve their suffering. The dying person suffers greater fear their loved one will go to jail if they help hasten their death.

Physician’s fall back on an oath written 2,000 years ago when physicians were thought to be gods because of their healing abilities and everyone thought the world was flat. Get over yourselves! They don’t consider that healing the soul and a peaceful death are what we need most of all at the end of our lives, not more false hopes and futile treatments that cause us more pain and suffering with no time to say goodbye to our loved ones.

Yes, palliative care is crucial and will be able to help most people achieve a peaceful death through pain management, but it’s not yet available everywhere, especially in rural areas, and it doesn’t work in all cases so it’s not a panacea. Hospice is not even available everywhere and with budget cuts they are often understaffed and out-of-reach.

The way the law is written almost no one can qualify to begin with. Only if you have a disease, like cancer, either for which there are no more treatments or patient has stopped treatments allowing nature to take its course, can a doctor with any degree of certainty predict a person has 6 months or less to live… which is why many people outlive a 6-month prognosis. Many people get better under hospice care because they are so well cared for and are no longer being subjected to the side-effects from  treatments meant to keep them alive with no quality of life.

And if you say you want to die, according to psychiatry, you are automatically diagnosed with depression; therefore you don’t qualify for the medication. So we’re spending a lot of time and money debating an issue that affects a relatively small number of people as if we were fighting against a trend toward genocide, all because we are afraid that death is the worst thing that could happen to us.

Most people wait too long to request hospice where they can also receive pain management so public education about palliative care is an important factor in end of life care. People are afraid hospice means the end, but it really means time to spend with your family, reconcile your life, get your paperwork in order, wrap up the details of your life, write out your last wishes, complete your bucket list, reconcile your life and say your goodbyes.

Yes, even to have a “suicide party” as one lawyer testified about with much disdain. It seems hearing what your loved ones have to say about you and saying your goodbyes before drinking a last toast is less acceptable, more fearful, than after the fact in an impeccable funeral parlor with everybody crying instead of laughter and hugs around the bedside at home.

Most people die after being rushed into the ER, resuscitated, and hooked up to machines in an ICU for a number of days, usually scared shitless and completely unconscious of the agony their family is going through because they didn’t let their last wishes be known. The last memory the family is likely to have of their loved one is of them dying in fear and agony with no opportunity to say goodbye.

If I were able to take a test that showed I was likely to develop Alzheimer’s Disease, I would be stocking up on pills and planning my exit strategy. If I were told I had pancreatic cancer, I would start working on my bucket list, planning my farewell party, and requesting my lethal prescription. In any case, I would not turn myself over to medical science hoping for a miracle out of fear of death… because I do not fear death.

I died once and I know there is nothing to fear. It’s like stepping out of an old worn out overcoat into the sunshine on a spring day filled with love, peace and joy on our journey home!

To fear death is nothing other than to think oneself wise when one is not.
For it is to think one knows what one does not know.
No one knows whether death may not even turn out to be the greatest blessings of human beings.
And yet people fear it as if they knew for certain it is the greatest evil.

–Socrates