Love Your Life to Death

Yvonne Heath is a wife, mother to three amazing children and a nurse since 1988. She has worked in ten different hospitals in Ontario, New York, Louisiana and Texas, and has nursed in the emergency room, long term care, medical and surgical units, intensive care in chemotherapy and hospice. Yvonne has witnessed a great deal of suffering, pain and death phobia, and felt it in her own life. She is the author of Love Your Life to Death.

To those who want to live well…and die well.

What if we planned our lives well instead of just going through the motions? What if we planned our end of life—long before a diagnosis, long before we were dying? What if we learned about grief before the grief so that we could be better prepared for it? Imagine…

We have come a long way with palliative care and hospice, but have a long way to go. Many still cling to quantity of life at the expense of quality of life. Over the years, I have had many patients tell me they are ready to die but their families are not ready to let them go.

Death phobia causes excessive suffering for the dying individual and for those who are left behind to pick up the broken pieces. Parents often do not want to expose their children to death, creating death phobic adults in the future. How then, can we build resilience? How can we learn that our broken hearts will heal?

While I love being a nurse, I have always felt I also had another purpose – to help more people than I could reach in my day-to-day work. My mission now is to bring death out of the darkness and into our conversations, to help eliminate excessive suffering when grief and death do arrive.

When we learn to talk about and plan our life and death, something amazing happens. We live more fully and suffer less at the end of our lives. And so do our loved ones.

I am devoted to helping people learn to live well and die well, and to create compassionate communities. It takes a village to care for the ill, the caregiver, the dying and the bereaved. We need to take good care of each other, but we must start with taking care of ourselves.

I have learned from those who have grieved deeply, care for the dying, from patients and those who have a story to share. As an author and speaker, I share these beautiful stories, as well as my own experience.

Thoughts on Physician Assisted Dying

It has been an incredible month. We attended conferences in Texas, Ontario and California. We are home now, absorbing the learning, and trying to integrate what we learned into our beings. Most profound for me was the opportunity to attend sessions addressing Physician Assisted Dying.

The debate is over. Physician Assisted Dying has been legalized in Canada. Health care professionals and administrators in hospices and palliative care (HPC) now need to develop policies outlining what services their HPC program will and will not provide. Physicians need to decide how to respond to requests, whether or not they are willing to provide a “hastened death” and if not, then decide who to refer people to. Nurses need to decide how they will respond, both within their formal work setting, but also, how they will respond as a family member or friend when the questions about hastening death are raised.

The entire health care team will need to reflect on how to respond when someone chooses a hastened death over the services of hospice and palliative care. Will we feel like we have failed? And if we feel that we have failed, how will we sit with that in the coming days, or more particularly, in the nights ahead?

As a nurse, if I choose to attend a death that has been hastened, how will that be for me and for the others who attend? Rather than witnessing the physical changes that often occur over a matter of days and hours, how will it feel to watch a person go from alive and cognitively intact, to waxen, cold, and dead,…. in just moments?

A few people have asked me what I think and feel about Physician Assisted Dying. I have avoided sharing my thoughts over the past years… but am willing to share my thoughts and the process I am going through today. Please read my thoughts knowing that like many of you, I am trying to make find my way in this new territory. These are my thoughts of the moment.

For much of my life I have been involved with caring for people and creatures who were dying. I cared for family, friends, community members and patients. For decades I sought meaning in caregiving and in dying. I found meaning and value in the last weeks, days and hours at the bedside. I searched for the benefits of family sitting vigil. I tried to find the good in the challenges that occurred. I came to believe that there was growth at the end of life, growth in the dying days, and sacredness in the act of caring for and being with.

Not only did I find value in the process of dying, I also sensed that on occasion the dying person was able to choose when they wanted to die naturally. Over the years I have been asked by friends to be with them when they were dying. Interesting to me, is the number of times when despite my limits and inability to be with someone constantly, I was there when they died.

For example: many years ago, when we were both young moms, my friend was diagnosed with breast cancer. I went to Vancouver to bring her home to the island. As I left her side at the hospital that night, I told her that I would not be able to return for ten days. I felt awful that I could not be there until then. I kept in touch by phone, and sent messages along. Ten days later I drove the island highway and made my way to her hospital room. Alongside her husband and her sisters, we companioned her. We waited with her and she died.

A similar story has played out many times since. Someone asking, “Kath, can you be with me when I die? Can you be with my family?” Try as I might to be there, I was often not able to attend 24/7 because of family and work commitments. Yet, often, death and I, were there at the same time. Natural death seemed to have a plan of its own.

With the legalization of assisted death, I look ahead and consider a new request. I can imagine that if I was in the Washington or Oregon, the request might be, “Kath, can you come and be with me when I take my medications?” or if in Canada, the request might be, “Kath, can you be here when I receive the injection from the doctor? Can you be here with my family?”

I wonder. How will I respond? In both cases, I do not have to be the one to give the medication. All that I am asked is to be present.

The request is simple enough. But then the planning. The planning seems surreal.

In Oregon and Washington states, once the person has met all the criteria, the person can set their own time and take the medications in the privacy of their own home.

In Canada, the dying person will need to arrange with a physician to inject the medication into their blood stream. What happens if the person decides they would like to live for another day, another hour? Would the person feel they need to go ahead with the plan because the doctor had arrived?

And as I think of the injections, I am reminded of the presentation at the Canadian Hospice Palliative Care Association conference by Dr David Wright, a nurse at the University of Ottawa, who is exploring the nursing perspective on this issue. David asked excellent questions: What does the nurse experience if the dying person chooses a hastened death over hospice palliative care? ….. He then asked… or was it someone else who asked, “Even though the physicians inject the medication, how many physicians do you know who can start an IV without the help of a nurse?” Nurses are a part of this process.

At the California Hospice and Palliative Care Association Conference, Anne Koepsell put forward four categories for how hospices respond to the requests for Physician Assisted Dying:
Embrace: hospice designates a social worker to respond to the requests, physician provides the prescription, staff are permitted to be present at time of death, and the hospice coordinates with Compassionate Choices.
Educate and support: hospice staff provide referrals to someone who is willing to discuss and assist with hastening death, the staff may or may not be present when death occurs.
Distance: hospice staff refer to a resource who will address the request.
Denial: hospice refuses to allow staff to discuss the request, and does not make referral.

At this moment in time, these are the three things that I know for sure:

1. I do not like the term “Physician Assisted Dying”. It is my opinion and my hope that physicians should assist every person in dying. Hospice physicians assist the dying person. They do not hasten it. So, I prefer instead to use the term, “Physician Hastened Death”, or “Hastened Death”.

2. I would like to see a world where everyone does have a CHOICE, a real choice, and I would like to see that Hospice and Palliative Care are one option. At this time, less than 30% of dying people receive services from a specialty Hospice Palliative Care team. When a person lives in remote and rural areas, when a person is not from a middle class Caucasian family, the person is much less likely to access HPC!

3. Finally, all HPC professionals need to be comfortable with talking with dying persons about the option to have a hastened death. They need to be able to hear the concerns and questions, to share the resources for hastened death, and to share what hospice and palliative care have to offer.

We, hospice palliative care professionals are at the bedside of people when they ask these questions. We, know how to talk about difficult things, how to talk about goals of care. We know the resources, we know the options, we can advocate. We are with friends and family when they ask questions about hastening death. No matter what people decide, we need to be comfortable with the conversation.

What are your thoughts on “Physician Assistant Dying”? Please leave your thoughts below, or chime in on our Facebook page.

New Competency Profile for Licensed Practical Nurses in Alberta

I am deeeeelighted to share that the College of Licensed Practical Nurses of Alberta has launched the 2015 updated Competency Profile for Licensed Practical Nurses!

And most exciting for me is the section on Palliative Care!

Have a look at the new Competency Profile for Licensed Practical Nurses, in particular (document) pages 142- 146 for the Palliative Care Profile. I was honoured to be asked to provide input in the development of these competencies, and am thrilled with the outcome of this document. These are the most specific palliative care competencies for LPN/RPN practice that I know of.

Why are palliative care competencies for Licensed Practical Nurses important?

When I started writing our new text for Practical Nurses (to be published in 2016), I looked for any competencies for Practical Nurses. I looked at the CASN competencies for Registered Nurses. I looked at the National education standards for “Unregulated Care Providers”, the “Ontario Personal Support Workers Vocational Learning Outcomes”, the European Interprofessional Competencies… but did not have a set of competencies that focused on the role of the Practical Nurse.

It is important to have competencies to use when developing and offering education. It is helpful to have competencies to standardize education within a province and across the country. As an individual, it is helpful to have competencies to help identify areas to learn and grown.

 

If I have missed competencies, and if you know of other competencies for Practical Nurses, or Vocational Nurses (as they are sometimes referred to in the USA), please leave a comment below, and/or email me.

Green Burials

Guest blog post by Susan Benesch – owner, and licensed funeral director, of Earth’s Option Cremation & Burial Services in Victoria, BC. Earth’s Option offers celebrations of life, funeral services, burial services, cremation services and specialize in green burials. They also provide a list of grief support resources and a pre-planning checklist on their website.

 

Green Burial has become an option available to families looking to minimize their environmental footprint when a loved one passes away. Being green and environmentally conscience has become a way of life.

What are considered alternative funeral rights and rituals?

In the past we saw traditional funerals, whereby every person was embalmed, dressed, placed in a casket and put on public display for viewing. The funeral ceremony would follow the next day with a long procession out to the cemetery. The casket would then be buried in the grave in a concrete vault and the top of the grave would have a granite headstone.

Today we see alternatives to the traditional methods of disposition of the body due to:

  • The perception of a lack of land
  • The high cost of traditional services
  • The transient nature of our communities (people no longer have roots to one community for generations)
  • The relaxation by the church to insist on traditional burial versus cremation

For these reasons greater Victoria has approximately 93% cremation – the highest in North America. As cremation deals with the disposition of the body so quickly, this affords families the ability to take their time to plan a celebration of life whereby there are no time constraints to worry about the body being present at the ceremony or service. The emphasis now is on the life lived and not on the body, as it once used to be. People are finding unique ways in which to celebrate the life of their loved one. Families are choosing to bathe the body themselves, perhaps even dress the body themselves. In addition to a more traditional funeral, some families are choosing a ‘celebration of life’ that may take on a less sombre tone, in fact, for some it can be more of a party atmosphere where often DVD videos are showing of the deceased’s life. The Internet is being widely used to share these memories with family and friends worldwide. At Earth’s Option we have been actively promoting green burial and the added involvement of family members in the process.

What is green burial?

It’s a process whereby the body is buried in a simple biodegradable container or shroud. The body is not embalmed and it is typically buried in a place of interment designated to go back to the forest or natural setting. There are no specific gravestones to mark the grave however there can be the use of a communal marker. When the burial takes place indigenous plants are placed on top of the gravesite. The fundamental idea behind a green burial is that there are no man made products in the grave or intervention in the process of the natural decomposition of the body. In greater Victoria the only designated natural or green burial site is located at the Royal Oak burial park. It is important to note that some cemeteries who claim to offer green or hybrid burials may in fact still include some man-made product’s in the grave, including caskets and/or concrete burial vaults. This is only a means to capitalize on the green movement as it is not truly green burial.

The Victoria region has been the leader in the province of BC in the green burial movement. As such, the Green Burial Society of Canada is situated in Victoria and its goal is to see green burials offered across Canada.

At Earth’s Option we offer one price for basic green burial. Additionally, one would pay for the basic shroud or the basic green burial casket. There are several choices of caskets all of which have no man-made products including lacquer, paints, metal, etc. Families are invited to consider pre-planning and preparing for the services.

 

For more information on Earth’s Option, please visit their website, visit them on Facebook and follow them on Twitter.