Archive for the ‘End of Life’ Category

Death Racketeers Do Not Want Advance Directives to Diminish Their Booty

Sunday, August 16th, 2009

Grandma and everyone else is going to die. That is a fact. What death racketeers don’t want is to give up the many hundreds of billions of dollars looted in Grandma’s and everyone else’s death-prolonging care. Their imminent deaths are unavoidable and undeniable. Instead, these death racketeers focus on how much revenue they can generate before death can no longer be prolonged.

Given a choice, i.e., an advance directive opportunity, Grandma and most others would choose a peaceful death rather than to be tortured by futile medical care. Yet, many in the medical-hospital-industrial complex thrive on death-prolonging medical care. They are fighting to keep their booty.

For most of us, it is NOT about the money since we know many more billions are spent on actual life-saving and life-prolonging care. No one quibbles or would ever want to deny this medical care. It is unrewarding to the patient and family but very monertarily rewarding to the medical care providers that is the issue.

Death racketeers are using scare tactics like “death panels” to garner support against the Advance Directives provision. They are not unethical but instead a-ethical, i.e., they have no ethics. They worship the almighty billions of dollars and care little about the pain and suffering without gain that their death-prolonging care delivers.

Shame on all the un-enlightened ones who have been duped into supporting death racketeers. Shame on death racketeers for worshiping the dollar more than their fellow human beings.

Do Anti-Psychotics Truly Harm Severely Demented Patients?

Tuesday, July 15th, 2008

The ethical principle of double effect is well understood in Medicine. Basically, it states that unwanted and unintentional bad effects are acceptable when the intent is to do good. Patients who undergo procedures sometimes have unfortunate and unavoidable consequences that may include death. For every attempt to do good a possibility of doing harm exists. So, why is there alarm over the untoward effects of potent anti-psychotics on advanced demented/Alzheimer’s patients?

By the time demented patients required anti-psychotics, they have lost their sentience, i.e., awareness of self and others. So, the control of unruly behavior cannot include verbal appeals and medications are the only alternative. Not infrequently, the unruly behavior is so severe that only potent anti-psychotics manage to re-established some semblance of control.

Recently, some have reported alarming and fatal side-effects to the use of anti-psychotics in severely demented patient and have warned against their use. These alarms have probably lead to less inappropriate AND appropriate use of these agents of control.

In the past, the physical restraining of these patient was condemned and essentially regulated out of use. It now appears that medication restrains may be going the same way. This would leave medical care providers with no options but a padded room. Even then self-harm could not be prevented.

If a life-ending side effect in an unruly, non-sentient demented patient occurs where is the harm? Up to 3% of sentient patient going to coronary bypass surgery die before leaving the hospital and this untoward effect has NOT stopped these bypasses from being performed daily. The principle of double effects permits these procedures to go on.

In the same way, the appropriate use of potent medications, i.e., anti-psychotics, for unruly demented patients must also be permitted. If an unintentional life-ending side effect occurs, so be it. Their physical deaths are frequently not as painful as the psychological and social deaths that the dementia had caused.

Being Prepared: The Key to Successful Death

Sunday, June 22nd, 2008

Paradoxically, death is the only prerequisite for life. Therefore, in order to be alive death must occur. Otherwise it is not life but instead immortality. If this is true, then why is death so poorly managed in our American society?

Death is treated as unwanted and unexpected by most Americans. It is as if it isn’t suppose to occur because it is not discussed and the subject is avoided. Out-of-mind means that death will not occur. This childish and naive thinking is part of American’s immaturity. It is time we grow up and acknowledge ‘the elephant in the room.’

Baby boomers have seen their parents pain, suffering and poor quality of end-of-life and many have vowed not to let that happen to them. Yet, they remain legally, psychologically and socially unprepared. This preparation is key to experiencing a successful death.

Legal preparation for death includes Advance Directors which can be codified as Living Wills, Directives to Physicians, Durable Power of Attorney and outpatient withholding or withdrawing life support interventions. Regular Wills and estate planning are also necessary. Even many of those who have these legal preparations are still not prepared for death because they have ignored the psychological and social aspects of preparation.

Psychological preparation for death requires that one live in the moment instead of dreading the future. One must accept ones lot in life and do their best in each moment. No one can ask for anything else. This also means that all primary feelings (emotions) are legitimate and that meta-feelings (i.e., feeling about feeling such as shame, remorse, embarrassment) need to worked out. As noted, ‘rule with your hear and live with your conscience’ means being true to one primary feeling. Yet, while legit to feel one feeling, what one does about them is what makes us human and prepares us for death. While feelings are legit, all actions are not. We are responsible for our own happiness but not at the expense of others happiness.

Social preparation for death means recognizing the others who are also suffering in the death of a loved one. All attention is paid to the dying person to the exclusion of those who will remain after the death. Their suffering and needs go unaddressed. These needs include ‘the talk’. The talk is the intimate soul to soul communication of the love, pleasures and sorrows of their interrelationship and a formal letting go or good-bye. It includes accepting that the relationship will die with the death and that those remaining will have to grieve and continue on. What ‘needs to be said’ should be said in this conversation; so that there are no regrets or remorse about something left unsaid. Funerals are too late to express ones feelings to a dead person.

If I can say to myself, “If I die today, I would have no regrets”, then we are as prepared as possible for death. But if we cannot say that, then we should ask ourselves, “What will I regret?” and then do whatever necessary to remediate these issues. Tragically, some will remain unremediable. Being at peace means not having remorse or regrets about ones death.

A successful death, as much as that is possible, requires legal, psychological and social preparation. Since regardless of preparation, death will come it makes sense to prepare.

Celebrating a Life Before Death: The Awake Wake

Tuesday, May 6th, 2008

The only prerequisite for life is death. Except for a couple of biblical exceptions every living thing has died or will at some time die. In spite of this fact, the end-of-life is poorly managed by most people. Many have regrets or remorse at the funeral regarding not having done or said something they wanted to do or say. The is an answer–the Awake Wake or some suitably named function.

The Wake is an Irish tradition of having a party with the person believed dead present. This tradition started before science was able to accurately determine death and some people in comas were thought dead. It was presumptive evidence that if the person believed dead did not wake up during the boisterous party, then they were really dead.

Wakes or like events are still traditional even though no one expects the decease to awaken. They are memorial services where survivors and other can mourn. Eulogies are common and many of these eulogies express regret or remorse at not having had an opportunity to have a “good-bye” conversation with the decease. Then they elucidate what would have been said.

A new tradition is needed where the gathering is held before death. This is especially needed when the dying person is still cognizant and can be present for these good-bye opportunities. I call it an “Awake Wake” but it can be called anything such as “Good-Bye Party”, “Remembrance Gathering” or anything else desired.

This gathering can be a party, play, religious ceremony or scripted function as planned by the dying person and those sponsoring the function. Out of respect, it is mandatory that the dying person approve the function and agree to attend. Also, everyone that the dying person consent to may have a public or private opportunities for their good-bye visit.

We celebrate birth dates and many other events. We need to celebrate the end of a life while the person who is the reason for the celebration can still attend. It will provide closure and a lot fewer regrets and less remorse than now occurs among the survivors.