We know that sea levels are rising and we know that many coastal cities struggle regularly with resulting flooding, but how much do we know about where we are headed? Which cities are taking action to protect themselves and which are not taking enough action? Who will be hit the hardest and how much will the damage from sea level rise cost us? To help us understand its impacts, Eastern Kentucky University’s Safety, Security and Emergency Management Program put together this infographic, which discusses… View full post on Inhabitat – Green Design, Innovation, Architecture, Green BuildingEco funeral – Inhabitat – Green Design, Innovation, Architecture, Green Building
This guest post has been contributed by Dying with Dignity Canada.
Supporters of Death with Dignity laws in the U.S., including Death with Dignity National Center, point to the Supreme Court of Canada’s ruling decriminalizing physician-assisted death as a catalyst for their work. The ruling decriminalized physician assisted death for a broader range of people than the laws being promoted in the U.S.: competent Canadians with a grievous and irremediable medical condition, including an illness, disease or disability, that causes enduring suffering that is intolerable to the individual. The court did not define “grievous and irremediable” but it is clear it is not limited to terminal illness. In addition, someone who has dementia but is still competent to provide informed consent would qualify, provided their suffering is, at the time of the request, intolerable to them. The remedy from the courts includes both the prescription and administration of medication, so that individuals will not be compelled to end their lives too early out of fear they will lose the capacity to do so later on.
The Court has given lawmakers a year to write new legislation, either Federal or Provincial lawmakers can pass legislation, both can, and neither has to do so, though it is unknown which level(s) of government decide to act. The provision of healthcare is a responsibility that is shared by both federal and provincial governments. Naturally, if the federal government passes legislation on assisted dying that are within its legal jurisdiction, those laws would apply across the country. However, each province has the power to craft its own framework for assisted dying.
Opponents of the Supreme Court ruling immediately asked for the Federal Governemnt to overturn the Supreme Court’s decision by using the notwithstanding clause in the Canadian Charter of Rights and Freedoms, essentially an override rule, to be applied in order to overturn the decision of the court, butT that drastic course of action option does not seem likely. Should neither the federal nor provincial governments pass laws applying the Court’s ruling, physician-assisted death would then be regulated by existing healthcare legislation and professional standards surrounding the practice of medicine, the same way that other end-of-life treatments are regulated.
In any case, in a year’s time, the current legal bans on prescribing and administering medication will be invalid in circumstances set out in the decision. Physicians will be able to assist either by providing the knowledge or the means for a person to end their own life, e.g. by prescribing life-ending medication or by administering life-ending medication. The SCC decision does not compel physicians to comply with requests for assisted dying. “Nothing in this declaration would compel physicians to provide assistance in dying,” the ruling reads. However, whether a doctor will have a duty to refer such a request to another doctor or healthcare institution if they are unwilling to provide the service will likely be addressed through legislation or regulatory standards governing the conduct of physicians. Similarly, the duty to provide physician-assisted death by hospitals, hospices, and other institutions will likely be addressed in federal or provincial legislation. If it is not addressed in legislation physician assisted death will be a right, but it might not be an accessible option for all Canadians.
To learn more about this issue, please join Dying with Dignity Canada for a Q&A webinar with our CEO, Wanda Morris, next week.
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Karen Kaplan is an ordained rabbi and served as a hospice chaplain for seven years. Learn more about Encountering the Edge and read book excerpts on the publisher’s site or Amazon. You can also see Karen’s own blog, Offbeat Compassion.
Death with Dignity National Center’s Melissa Barber asked me as I prepared this post, “Why did you write this book?” This is something every author should keep in mind throughout the writing process. It implies, among many other things, that a solidly cogent answer must precede the genesis of any worthwhile book.
While writing my hospice chaplain memoir, I kept in mind how the author of Ecclesiastes admonished his son: “Of making many books there is no end; and much study is a weariness of the flesh.” And I was acutely conscious of needing abundant justification for writing Encountering the Edge: What People Told Me Before They Died.
Melissa’s question is also an excellent tool for self-reflection. It’s one thing to explain what a reader might get out of it, and quite another for authors to delve into the spiritual reasons underlying their endeavors. (The psychological reason is yet another dimension, and this is dealt with in the book.) I’ll now endeavor to take on both challenges.
Particularly for Death with Dignity followers, I think Amy Glenn Wright, columnist and blogger for Philly.com, summed up the why-read-it question in her review most succinctly: It’s a “needed reminder to reflect upon mortality in a culture built upon marketing the latest stimulant and distraction. What meaning can be found when facing the end of life? What legacy does each individual leave behind?… [This book inspires] reflection upon the significance of death’s inevitability and the beauty of existence.” In other words, I delved into the meaning and spiritual importance of those facing the loss of themselves and of their loved ones.
In Encountering the Edge I give a fly-on-the-wall account of what some of my patients said to me during my visits. These true stories show what they cared about, laughed at, wanted to talk about and wanted to avoid. This account also shows what hospice is like from the chaplain’s perspective, including the tremendous travel time involved and how chaplains handle the misuse of religion in patient care.
The fact that the memoir carries no religious message and doesn’t leave the reader with conventional answers, speaks to the deeper spiritual reason I felt compelled to put myself out there with this book. I feel my purpose as a chaplain is to provide an open and sacred space for people to articulate whatever is on their minds unimpeded by hidden agendas—including religious ones.
I think this is what defines authentic interaction, particularly when the subject is crucial such as pondering the purpose of one’s life. I have aspired to make the book work for the reader in the same way: These vignettes of patients and their families show their values, struggles, memories and pleasures at the moment I am listening to them. The act of concentrated listening helps them articulate these concerns and consequently gain more self-awareness of the import of what they have expressed. I hope this book will give readers their own space to freely reflect upon how facing loss shapes the unfolding of their own life paths and their own final chapters.
Editor’s note: Blog posts on Living with Dying about arts and humanities aren’t endorsements of these books or movies.
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For years, many state lawmakers have been working quietly to put forward Death with Dignity legislation, and with the recent shift in the national conversation around end-of-life healthcare policy reform, some politicians are taking a more vocal stance. Within the last few years, Vermont Governor Peter Shumlin made Death with Dignity part of his campaign platform; New Jersey Assemblyman John Burzichelli introduced and is championing his proposed Death with Dignity legislation; and Pennsylvania State Senator Daylin Leach has begun being more vocal in his support for the Death with Dignity bill he proposed.
His bill emulates our model legislation, the Oregon Death with Dignity Act. In an editorial published this week, Senator Leach outlined why Pennsylvania needs to follow in the footsteps of Oregon, Washington, and Vermont. He pointed out how Americans want and seek out options in all facets of their lives:
The desire for choice seems to be in America’s DNA. As a people, we demand a cornucopia of choices in virtually every aspect of our lives. We demand everything from 31 flavors to 800 channels. We go to The Cheesecake Factory to choose between 300 menu items, in a mall with 400 stores…Yet we have, for the most part, passively accepted the denial of any choice in the one area of life where it perhaps means the most. In most places in this country, we can not choose how we want our lives to end.
He went on to explain specific provisions of the proposed Pennsylvania legislation:
The bill requires that any person wanting the medication fill out and sign a notarized form, indicating that they themselves were making the request. They would then need two separate doctors, a treating physician, and a non-treating independent physician to attest that the patient has a terminal disease and has less than 6 months to live. Only then would the medicine be disbursed.
Senator Leach addressed opponent’s false assertions which we’ve heard since Oregonians voted on the groundbreaking Death with Dignity Act in 1994; he pointed out the proposed law would only be an option for people who are clearly dying as a result of a terminal illness. He also reflected on the experience of people who’ve exercised their rights under other states’ Death with Dignity laws that “just having the medicine, and the options it brings, is enough comfort to enable them to keep going.”
Poignantly, he ends his op-ed by summing up the true aim of Death with Dignity laws: patient centered care.
Ideally, the end of life is a time filled with sadness, but also sweetness, reconciliations and meaningful goodbyes. It is an intensely personal time that should be choreographed and lived by the person and the family affected.
Senator Leach’s editorial is part of the growing public demand for laws to allow terminally ill people to decide what’s best for themselves in their final days, and it’s refreshing to see more and more politicians calling on their fellow lawmakers to stand up and respect the will of the people.
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Getting an important cause noticed by a large group of people is a challenge—it’s especially difficult when an issue is about something many people don’t want to talk about: death. What a difference it makes when one of the major papers in the US publishes an article on the front page of their Sunday edition.
Last Sunday, the New York Times published an informative article by Katie Hafner about assisted death and Dignity 2012′s effort to ask Massachusetts voters how they feel about Death with Dignity. Hafner’s article covers a lot of ground in a relatively short space. She shares the story of a Washington state doctor’s decision to request the medication, his physician’s and wife’s feelings about his decision, and even covers how the main myths regarding the Oregon and Washington Death with Dignity Acts have been debunked by years of data and research.
I’ve been watching the chatter on social media about the article, and the personal perspectives shared in it, such as this one, are mentioned most often:
Dr. Richard Wesley has amyotrophic lateral sclerosis, the incurable disease that lays waste to muscles while leaving the mind intact. He lives with the knowledge that an untimely death is chasing him down, but takes solace in knowing that he can decide exactly when, where and how he will die.
And anecdotal observations like this one capture many people’s attention:
There are no studies of the psychological effect of having a prescription on hand, but experts say many patients who have received one find comfort in knowing they have or can get the drugs. About a third of those who fill the prescription die without using it. “I don’t know if I’ll use the medication to end my life,” Dr. Wesley said. “But I do know that it is my life, it is my death, and it should be my choice.”
On the other hand, reactions to the article published on news sites and blogs have focused more on the facts about Death with Dignity Acts and how the original fears spouted by opponents haven’t happened. Dr. Bruce Wilson, a former hospice medical director, discussed these facts in an article featured in Milwaukee’s Journal Sentinel:
When one looks into physician-assisted suicide (or even euthanasia, which is illegal in the U.S., but legal in seven countries), one finds that the patients who choose these methods are not so much trying to orchestrate how they die, but how they will live in their remaining days.
Protecting high-quality time with their friends and loved ones is the goal. They wish not to lose dignity, or independence, or precious hours, days or weeks by undergoing aggressive treatments that cannot “cure” their diseases. This is what the data shows over the 14 years that this law has been in place in Oregon.
Understandably, the argument has been that this puts us on a slippery slope. What is interesting is that there does not appear to be one.
In no state where physician-assisted suicide is legal, or any country where euthanasia is practiced, has there ever been a vulnerable person who had this type of a decision made for them. In fact, the safeguards against this are many, and layered.
Nikki Tucker from Medical Daily described the safeguards in the law and how they’ve made sure everyone involved in the process is protected:
Both Washington and Oregon use meticulous and strict guidelines to determine who will be considered to receive the drugs. Two physicians are required to confirm that a patient has a maximum of six months left to live. The requests must be made twice, with each request made 15 days apart, before the prescriptions are given. The drugs also must be self-administered.
For an editorial writer in Astoria, Oregon the New York Times article brought back memories of Oregon’s debates in 1994 when the voters approved the state’s law—the first in the nation.
When Oregonians debated this proposal 18 years ago, opponents raised the specter of terminally ill people moving to Oregon in large numbers to kill themselves. There was also fear that indigent people would be forced to use the law. Hafner quotes researchers at Oregon Health and Sciences University who note that neither of those outcomes have occurred.
Roman Catholic bishops injected religion into Oregon’s debate, but the topic on voters’ minds was pain and self determination at the end of life. That same dichotomy is playing out in Massachusetts. Our debate and our law caused physicians to pay more attention to palliative care. Oregon’s example is being studied elsewhere. That’s a good thing.
A good thing indeed.
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Information about Green Burials and Passages International
Arabella talks about the natural burial charity and Trust ‘Eternal Forest’ at Boduan. Pen Llyn
First Green Burial At Circle Sanctuary. www.circlesanctuary.org www.celiaonline.com