Ghana's dancing pallbearers - BBC Africa

The New Urgency of EOL Conversations Because of COVID-19

Many doctors have asked: is this the calm before the storm? As more people start to get acute respiratory distress syndrome from this virus – and they will – it will get more difficult to manage. Are we going to be trying to assess our older patients with comorbidities in a telephone consult to ascertain whether they should go to hospital? Should we be starting to talk to all our patients about what their plan is if they get the virus?

Absolutely, we should. Any patient being admitted to hospital may not survive and may not see their family again. Especially if they are elderly and/or with comorbidities.

Steve Carroll, a US emergency physician said last week: “Patients are arriving without family or friends. Now we make sure they call their family before we put them on a ventilator. Because they may never get to speak to them again.”

COVID-19: Time to get serious about end-of-life discussions

COVID-19: Who lives, who dies, who decides

I used to work on some of these issues in the government: should we ban a pesticide that will cause two cancers a year if banning it will raise the price of a bushel of strawberries 50 cents?

As this article discusses, we are terrible at making these trade-offs. When one child falls down a well, we spare no expense in rescuing her, clearly the right choice. But when it comes to deciding whether all wells should have walls around them to make sure no other child falls down, we are not very good at figuring out the right answer. If there is one.

How would have you responded if a year ago the President asked everyone to make a plan in case there was a pandemic? Would you vote for a candidate because he or she had an expensive contingency plan for a virus?

An isolation-induced recession would reduce economic activity by roughly 21 percent, compared with 9 percent under a more lax approach, according to a ballpark estimate by economists Martin Eichenbaum, Sergio Rebelo and Mathias Trabandt. It’s not unreasonable to assume that strict containment could cost $2 trillion. These same authors estimate that such measures would prevent more than half a million deaths and protect millions of other Americans from becoming infected. If their analysis is even roughly right, these are huge health benefits and huge economic costs. Which path has more value? The answer isn’t obvious.

American policymakers have rarely been forced to consider such trade-offs during a massive pandemic. But we have spent decades trying to understand other trade-offs that help put them into context: How much should Medicare pay for a new lung cancer treatment? Should we require a car to have a $700 air bag? Should a company have to spend millions of dollars to remove contaminated soil beneath a remote and abandoned industrial site?

Who lives, who dies, who decides

Canada debates offering physician-assisted death to patients who aren’t terminally ill

Ron Posno has early-stage dementia. He wants to make sure that if his capacity becomes so diminished, he can take advantage of Canada's assisted death law. But it does not provide for people with dementia.

Posno figured Canada, which in 2016 passed a federal law on what people here call medical assistance in dying, would be a place where he could set out his wishes to die on his own terms while he was still competent. As it turns out, “advance requests” like the one he tried to make are not allowed.

Now the government of Prime Minister Justin Trudeau has introduced a bill that would overhaul the process.
Polls show widespread support in Canada for broadening access. But much like the law it is intended to replace, the bill has faced criticism — for being too restrictive or too expansive or too confusing.

For Posno, “it failed dementia patients again completely.

...

Canada’s law is more liberal than those of the U.S. jurisdictions where the practice is legal. In those jurisdictions, which include California, New Jersey and the District of Columbia, only mentally capable, terminally ill patients with a prognosis of six months or less who can self-ingest the drugs are eligible.

But implementing the law in Canada has not been without challenges.

Doctors puzzled over the definition of a “reasonably foreseeable” natural death. Ellen Wiebe, a physician based in Vancouver and one of the first in Canada to provide medical assistance in dying, remembers hashing out policies in email discussion groups.
Criticism exploded in 2018 over the case of Audrey Parker, a 57-year-old woman with terminal breast cancer that had spread to her brain. Fearful that the disease might rob her of the mental cognition to consent a second time, she scheduled her death earlier than she otherwise would have wished.

Doctors reported that patients were forgoing pain medication, even though it increased their suffering, so they could provide that second consent.

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Canada debates offering physician-assisted death to patients who aren’t terminally ill

Lifestories: Someone Had to be Benny (1996) [1/5]

A young man chooses to stop treatment and has to go to court in HBO's "Someone Had to Be Benny" (1996).

The Widow's Lament in Springtime by William Carlos Williams

The Widow's Lament in Springtime
by William Carlos Williams

Sorrow is my own yard
where the new grass
flames as it has flamed
often before but not
with the cold fire
that closes round me this year.
Thirty-five years
I lived with my husband.
The plumtree is white today
with masses of flowers.
Masses of flowers
load the cherry branches
and color some bushes
yellow and some red
but the grief in my heart
is stronger than they
for though they were my joy
formerly, today I notice them
and turn away forgetting.
Today my son told me
that in the meadows,
at the edge of the heavy woods
in the distance, he saw
trees of white flowers.
I feel that I would like
to go there
and fall into those flowers
and sink into the marsh near them.

What to Say to a Dying Person

Jenny Harrington writes about words of comfort for someone who is dying:

You will not be alone.
You will not feel pain.
We will be okay.




Three Magical Phrases to Comfort a Dying Person