Continuing with the subject of death, I wanted to talk about an amazing project that was started in New Orleans by an artist named Candy Chang. There was an abandoned building in her neighborhood and she got the idea after a good friend died to make a wall in tribute to her. She painted the side of one wall with black chalkboard paint and stenciled the phrase
"Before I die I want to ____________________________________" all over the wall.
By the end of the day the wall was full so she continued to paint the other walls. Ten months later someone bought the house and the project was finished there. But the project became known all over the world and has been replicated in 78 countries and 35 languages. Candy found the same themes emerged on all of the walls. She said we want to love and be loved, travel the world, see our loved ones thrive, be at peace with ourselves and on and on. She reflected on the project by saying, "...the wall became in ice-breaker for meaningful conversations on death and emotional health. Seeing some private corner of your psyche reflected in someone else’s handwriting on a public wall can be incredibly reassuring on an individual level, and it’s a step towards seeing ourselves in one another."
If you came across a wall like this what would you write?
Before I die I want to ______________________________________________________________.
For more information please go to: https://beforeidieproject.com/story/
Medical Aid in Dying
Last year I attended the funeral of a man I never met. He had a neurodegenerative disease that was quickly taking away his independence. He did not want to be a burden on his family or the medical community. He made the decision to use the Aid in Dying (AD) law which is also called the Assistive Suicide law. This is a highly debated and emotional topic. The American Medical Association (AMA) and the American Nurses Association (ANA) and many other organizations oppose the law and say that doctors and nurses should not be involved in the process. The ANA opposes nurses participating in AD activities because it violates the ANA Code of Ethics. But if we are not involved in the process how does a patient who chooses to end their life this way get advice and the needed medications? If nurses are asked to help with any type of patient assisted suicide they must refuse. Yet there are critical questions that should be asked before the patient and family seek this way out. Is pain being controlled adequately? If the pain were brought under control would the patient still want to use the medications? Is there a fear of a terrible death? Is there a fear of being a burden on their family? Are there financial concerns that a patient/family are concerned about with a protracted and prolonged dependence on the medical system? As nurses we can help with pain control, make a referral to a chaplain for fears about death or a social worker to help with financial issues. But above all if we are not allowed to participate, the patient and their family should know that someone cares and that they are not alone.
According to the UCLA Health system website on this topic a third of patients who opt for AD do not use the medications. The process to get the medications requires that a patient has less than 6 months to live, requests the medications from 2 different physicians, is over 18 years old, has the mental capacity to make the decision and has the physical ability to take the medication. The medications are not always covered by insurance and a pharmacist has the right to refuse the request.
I have always been an advocate for my patients and helped to educate them so that they could make an informed decision. The patient who chose AD was unsuccessful when he asked his neurologist and PCP to help. Both refused to attest that he only had 6 months to live which is a requirement of the law. I found 2 amazing physicians who helped him get the needed medications after meeting him once! He did not want to be a burden on his loved ones when he became bedbound and dependent for all of his care. And he did not want to put a drain on the medical system when he became too ill to stay in his primary residence. More than 80% of healthcare dollars are spent on patients in the last months of their life. This patient was accused of wanting to control everything up until the end. So? He did the research, he listened to opposing opinions, and he made an informed decision.
I never met the gentleman but I did go to his funeral. I wanted to see how his friends and family were reacting to his death. It was a sad funeral as everyone was crying and sad to see him go. From the testimonials and eulogies of not only family but co-workers, neighbors, clergy, and distant friends he was a well-respected and funny guy. I wished there had been laughter and joy. I am sure he was having a good laugh in Heaven watching the church fill up.
I hope there is someone like me when I am on the edge, waiting to pass over to whatever is next. To me it is just a change of address. My mother died over 40 years ago and my grandmother died over 50 years ago but I still talk to them in times of stress and when I need help to carry on. They have guided my way and helped me to become me. Who in your life do you talk to who has passed on? Who brings you strength when you are falling? What is your opinion of the Medical Aid in Dying law and would you help someone get the needed medications to end their life?
You may not agree with my opinion about this law and that is ok. But do it with an informed mind and heart.
