Monday, March 27, 2017

An Exit Guide on a mission

The other day, I had a conversation with a woman who was about to embark on a visit in rural Washington to be an Exit Guide. This term was unfamiliar to me, even having read Derek Humphrey's book, The Final Exit, a number of years ago. Humphrey was a founder of The Hemlock Society. The Society's name disappeared when it merged and became the more mainstream non-profit, Compassion and Choices.

Apparently some were unhappy with this and decided to continue the efforts of Humphrey. I must admit I felt a bit queasy when reading chapters in The Final Exit which explain how to tie a bag around your neck after ingesting medications, and how "to go together" with your loved one.

The Exit Guide I met is a retired physician though she said this wasn't necessary. She had joined and been trained by the Final Exit Network to be present with the person wishing to end their life. From her, I learned that pure nitrogen (N2) works well and the individual passes out without struggling in about 30 seconds and is soon dead from lack of oxygen. There are head-bag kits and videos on line for instruction and purchase. The individual she was visiting had some degree of dementia and lived in Washington State (where a death with dignity law exists) and this individual apparently did not qualify for physician assisted death.

I have so many questions. How much "assistance/instruction" can the Exit Guide give without being held legally liable? Do they remove the plastic bag and equipment before reporting the death, thus making it very hard to determine it was a suicide? How careful is the vetting? What degree of dementia is acceptable with their criteria? Washington State law says you have to be considered terminal within 6 months. What guidelines do the Exit Guides follow?

In addition to individual cases, some states are now looking to use nitrogen as the favored means for executions. There is a great deal of discussion about what's going on in Oklahoma.

For myself, I don't think I could become an Exit Guide. Could you? It's a question of a bright line between supporting an individual's autonomy and protecting their rights when mentally incompetent or not terminal. Making "how to" kits for head-bags and nitrogen, still makes me queasy.

Sunday, March 26, 2017

Please forgive me. I forgive you. Thank you. I love you.

Dr. Ira Byock recommends the use of these short sentences when stymied on how to talk to the dying. His wise comments come from his many years in Hospice and palliative care. You can listen to his comments here.

Friday, March 17, 2017

"Is Death in Trouble" - from the Hastings Center

Daniel Callahan wonders if death is in trouble. Have we pushed death back so far with the advances in medicine that we no longer die of old age? It's an interesting thought. Death may be intellectually inevitable but it's always touted as a "battle" and a "defeat." We expend billions looking to "wipe out" a condition only to have another take its place. I suppose what we're trying to do is flatten the aging curve so that there's an unexpected precipitous drop at the end rather than the dwindles. Heart attacks used to take us quickly, but now sudden death from a heart attack is in dramatic decline with cholesterol and blood pressure control. The unfortunate pervasive drug ads make us think that, yes, science will continue to solve that next problem for us, then the next. Really?

I wander into old age with a sense of unease. What's waiting for me? A fall with a broken hip? A lurking pancreatic cancer? A stroke? Or, God forbid, Alzheimer's. This is where a type of beneficent denial can help. Know the inevitable but get on with fun living - yes, a day at a time. Compartmentalize death. Expect loss, but move on. All easy to say, yet I'll keep trying as I close in to that point where the actuaries say I'm over the top. And I need to admit, it's not in my control.

The funeral as we know it is becoming a relic — just in time for a death boom

By   Karen Heller April 15 Ed note: Funerals are changing in ways that will bring culture shock and a shake of the head of s...