End-of-Life Decision-Making - Withholding Vs Withdrawing Treatment

By David Lemberg

Families will struggle with these choices, regardless of whether withholding or withdrawing treatment is being considered. For the ethics consultant, it's good to begin with the understanding that withholding and withdrawing are moral and ethical equivalents. That clears the playing field.

It seems likely that family members who are guilt-ridden - for all the things they did to and for the dying relative and all the things they didn't do - will have great difficulty with any of these choices. As they're losing their relative permanently, all the past can now never be made right. So there's a strong tendency to hold on regardless of the medical circumstances.

Such individuals could never be "responsible" for any proactive choice that would result in their relative's demise. As long as the relative lives, the family member's fantasy of resolving the guilt can continue. And, in no way could they be able to pile on more imagined guilt than they already have.

Withholding treatment might be more palatable, as the family member is only agreeing to the status quo. Withdrawing treatment would require taking action that would change the present circumstances. The family member cannot take on that responsibility in the face of the unresolved issues.

For the most likely small minority of families who are able to let their loved ones go in a humane and medically responsible manner, such questions might not arise.

Matters of withholding or withdrawing treatment depend on the specifics of the case. If there are reasonable expectations regarding quality and length of life, then beginning treatment with targeted reevaluation is appropriate. Withdrawal might be considered at a later date.

If the prognosis is poor from all points of view, and lifesaving measures would only keep the body alive with no other prospects, then withholding treatment seems most appropriate.

Of course, these are hypotheticals and necessarily sketchy.

A fresh perspective may be obtained by considering that our current medical expertise is only a modest upgrade from the days of leeches and bleeding patients. If the human race lasts another 300 years, future physicians and concerned citizens will look back on the 21st century with much of the same horror and bemusement with which we view early 18th-century medicine.

Cancer treatment provides a bracing context. Chemotherapy, ablative surgery, and radiation may be eventually viewed as barbaric rather than "heroic". From another viewpoint, these methods may be the best we have right now. But that doesn't suggest they should be used in all cases. Case-by-case evaluation and treatment would be the most humane approach.

Similarly with percutaneous endoscopic gastrostomy (PEG)tubing. Whereas these may be useful in the ICU in cases in which survival and quality of life are real considerations, such methods of artificial nutrition/hydration are not appropriate merely for ensuring continued life. What's the value of being alive when you're mostly dead?

In clinical bioethics, nothing is straightforward. It is critically important to have an open mind and leave one's prejudices and preconceptions at the hospital entranceway.

David Lemberg, M.S. in Bioethics, Albany Medical College, May 2010
Consultant, Author, Speaker. Research interests - health care and health care policy, reproductive technologies, genetics and genomics, K-12 science education
Executive Producer, SCIENCE AND SOCIETY, http://scienceandsociety.net
Twitter - http://twitter.com/david_lemberg
Visit SCIENCE AND SOCIETY for cutting-edge interviews with Nobel Laureates, trendsetting industry executives, and best-selling authors in the fields of cancer research, genetics, health care policy, nanotechnology, and space exploration.

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For more information, you might enjoy reading my book, More Than Meets the Eye True Stories about Death, Dying, and Afterlife. Purchase paperback on Amazon.com. It's also on Amazon as an e-book for those who have Kindle or Sony Readers. The audio book is now available!

Brain Injury and a Near Death Experience (NDE) Sparks Visions for an Artist

By Elizabeth Kirwin
Many artists have been deterred from realizing their fullest potential. Multiple obstacles might stand in their way: poverty, illness, injury, lack of support from family and partners, isolation, and/or little or no recognition for their work. How do artists who have strayed from their paths get back on track and continue to pour passion, time and energy into work that sustains their spirit and beautifies the world?

For this particular artist, Heather Ifversen, a life threatening head injury, caused by a fall in the bathtub, forced her to closely examine her life and dramatically change it. Brain trauma and a near death experience (NDE) and her subsequent convalescence and recovery awakened her enough so she could begin to live an authentic life again.


Ifversen's story is extraordinary and deserves to be told. She has chosen to illustrate this experience through narrative paintings. These paintings detail a profound and magical vision of the cosmos, and energies within it, which constitute the web of life. Central to her story is her self, and an astounding evolution which occurred during a period of six months or so, when she was contacted by beings made of light. Ifversen is still uncertain if these beings were real or a creation of her mind. Yet she seemed to have an ongoing conversation with them that had the effect of infusing her life with a new energy and most importantly - a drive to continue to create art. In her visions, which occurred during her waking hours, she first begged these light beings to help her regain life and full consciousness so she could come back and mother her girls, Isabella (12) and Finn (7). Slowly, as her consciousness began to reconstruct itself, and her motor skills, speech and portions of her memory returned, the one thing she was able to do in her bedridden state was to draw and paint again. "I strapped a paintbrush to my hand," recalls Ifversen, "and I began to paint the visions I saw in my head."


As she returned to life, she also reclaimed her identity as an artist. Her life as an artist had been eclipsed and almost lost as a wife, mother, caregiver and social worker. Tenaciously, like someone possessed by energies beyond her control, she clung to this identity that had always been hers. For these light beings who revealed to her the complex web of energies that form a backdrop to our existence had given her one more chance to live - and she was not going to waste it.


The work which was completed while recovering from brain trauma includes a staggering 60 paintings - completed during Ifversen's six month recovery. This art documents the strange and magnificent powers that lie behind the central truths of our world. Some may be inclined to be skeptical of Ifversen's story, but many, including energy workers and neuropsychologists might just be delighted by her revelations.


Anyone who travels the magical planes, works in the realm of faery magic, studies the mysterious pathways of the brain, or deals directly with people who have had Near Death Experiences (NDE) knows when these energies appear to be at work. In the case of individuals experiencing a 'normal life' -- a finely cloaked exterior often keeps them hidden from view. Perhaps the ordinary person is too distracted, or consumed by other matters, to see them as clearly as Ifversen has. The light beings she describes in her paintings are real enough to be painted.


According to Ifveren and others who've had these types of experience, these light beings work behind the scenes of the everyday, mundane world. Ifversen was walking between this world and that one for an elongated period of time. Having lost her ability to speak, read, or write, she chose to paint this reality. Happily, she returned to her brush, canvas and palette and used what little strength she had then to record her journey.


Elizabeth Kirwin is the creator and founder of FairesInAmerica.com, a website that gives insight into the fairy culture of the United States, a branch of neo-paganism that is on the rise. Kirwin is a professional writer, performance artist and Organic SEO specialist. Visit http://www.fairiesinamerica.com or email info@fairiesinamerica.com.


Article Source: http://EzineArticles.com/?expert=Elizabeth_Kirwin

~~~~~~~~~~~~~~~~~~~For more information, you might enjoy reading my book, More Than Meets the Eye True Stories about Death, Dying, and Afterlife. Purchase paperback on Amazon.com. It's also on Amazon as an e-book for those who have Kindle or Sony Readers. The audio book is now available!
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End-of-Life Decision Making For Cancer Patients

By Pauline Go

People who are in the last stages of cancer should pay some attention to end-of-life decisions. The most important is advance directive, also known as living will, for medical treatment. This is nothing but a document written by the terminally ill person while he or she is still capable of making decisions. The advance directive basically states that the patient does not want artificial means of surviving should he or she become mentally incompetent. Artificial life saving measures include CPR, respirators or anything else the person can think of.

The reason why advance directive only applies to a person who in mentally incapable of making decisions is because prior to that a doctor can ask the person what his or her preferences are about the treatment. However, once the person becomes mentally incompetent, he cannot be asked to state to state his or her preference.

However, advance directive is not only about dying with dignity. There are some patients who might want to live as long as possible using CPR or artificial breathing machines. If this is mentioned in your living will, the doctors and your family would have to respect it. In fact, the doctor would have to do everything to save your life or prolong it.

Those who find writing advance directive morbid, do not have to do it. Instead they can appoint a health care agent. This is someone who makes all the healthcare decisions on your behalf when you are incapable of making them. However, you would have to tell the agent what your wishes are while you are still able to think and comprehend coherently.

Pauline Go is an online leading expert medical industry. She also offers top quality articles like:
Lung Cancer Facts,
Bone Cancer Symptoms
Article Source: http://EzineArticles.com/2184874

~~~~~~~~~~~~~~~~~~~For more information, you might enjoy reading my book, More Than Meets the Eye True Stories about Death, Dying, and Afterlife. Purchase paperback on Amazon.com. It's also on Amazon as an e-book for those who have Kindle or Sony Readers. The audio book is now available!
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End of Life Plan - Not Just For the Elderly

by Laura Bramble

Most people live with a fear of being debilitated and unable to make end of life decisions, whether by accident, disease or aging. Mental autonomy is a vital part of our identities and it is hard to imagine life without it. Yet many face that very situation every day. Having a clearly defined, written plan that close friends and family understand goes a long way in relieving some of that fear.

Like wills, people approach end of life plans with hesitation. These plans are seen as morbid or as bringing bad things into being. Younger people feel that there is plenty of time; only "old people" need to plan ahead and declare their wishes. However, many who need end of life plans are not those who are dying a slow and dignified death with plenty of time to set things in order. Accidents and sudden illnesses create situations that render the victim incapacitated and unable to make decisions for himself, the very situation that requires this kind of plan. The suddenness of the condition also leaves family members to deal with a large number of issues and emotions at onbe, besides the burden of having to make decisions for a loved one. Having a plan in place keeps loved ones from having to think about those issues while they are in the midst of coping with their emotions and prevents them from ever wondering if they did the right thing and respected your unknown wishes.

A basic end of life plan deals with a few issues: life support and extraordinary medical measures, organ donation and funeral arrangements, hospice care and financial issues. Whether a patient wants doctors to keep them on life support for an extended period or resort to complicated or risky procedures on a faint hope of success needs to be spelled out, since making that decision means condemning a loved one to death. This is a very pressure filled situation for a grieving loved one. For those that have definite feelings about how they wish their body to be handled after death, especially those with strong religious convictions, putting directions in writing removes any guesswork and ensures that their final wishes will be met. Some people are comfortable with the idea of hospice care, while others would rather die at home, surrounded by familiar people and things, which an end of life plan makes clear. An end of life plan also creates arrangements for the support of spouses and children, temporary custody and guardianship, and funding for medical and funeral expenses.

It takes a team to develop a solid end of life plan. Especially if you are ill or elderly, speaking with your doctor about what to expect and getting answers to questions can help you settle the medical issues surrounding long-term care and life support. An attorney can give legal advice on the best and smoothest way to handle any transfers of property or authority. A financial advisor who specializes in estate and succession planning can advise you on the most effective way to structure your finances to guarantee that funds are in place to cover expenses while minimizing the tax burden on loved ones.

Laura Bramble is a freelance writer living in Atlanta. You may view more of her work at walkers for seniors or walkers with wheels

Article Source: http://EzineArticles.com/?expert=Laura_Bramble

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.For more information, you might enjoy reading my book, More Than Meets the Eye True Stories about Death, Dying, and Afterlife. Purchase paperback on Amazon.com. It's also on Amazon as an e-book for those who have Kindle or Sony Readers. The audio book is now available!
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The Legacy of Love We Leave Behind

Today we welcome Marilyn L. Geary and Jacqueline Janssen, authors of the new book LeaveLight, to our writing blog. They share a discussion about their book with Sarah Moore with Writers in the Sky Creative Writing Services.

SARAH: Please share the premise of LeaveLight so that we will know something about the genre and content of your book.

MARILYN: LeaveLight is a spiritual and practical guide to advance planning and leaving a legacy for your loved ones. It offers tools that motivate you to provide directions for your loved ones in the difficult time after your death. LeaveLight makes this easy by helping you organize your life’s planning into a Legacy Binder that contains your personal data and information on your health, your possessions and your final wishes for you and your family.

JACQUELINE: LeaveLight provides exercises and visualizations that help you focus on the qualities of forgiveness, compassion, gratitude and surrender. By reviewing your life and its relationships, you are able to move forward with fewer regrets. LeaveLight does not offer legal, financial, or therapeutic advice. It does offer motivation and resources to assist with advance planning.

SARAH: How is the book formatted? What kind of layout and content can readers expect to find inside?

MARILYN: We have divided LeaveLight into chapters that help readers complete their planning. After an introduction and a chapter on “Getting Started,” LeaveLight leads the reader through six chapters. The first chapter focuses readers on motivation and purpose. The next four chapters are based on the four natural elements, four seasons and four human qualities:

Air—Your Spring of Forgiveness, which addresses your personal data

Water—Your Summer of Compassion, which includes health topics, such as advance directives

Earth—Your Autumn of Gratitude, which concerns decisions regarding both material and intangible assets

Fire—Your Winter of Surrender, a chapter on planning final arrangements.

In the last chapter, Coming Full Circle, the reader creates a legacy letter spelling out wishes, decisions and values for loved ones left behind.

We have included forms for documenting useful information and a list of resources in the appendix.

SARAH: What inspired you to write this book?

MARILYN: One evening over a meal at Café Gratitude in San Rafael, California, Jacqueline and I were talking about things we had not finished, including putting plans together for our family members should something happen to us.

We found that we both had experienced unnecessary trauma after family members had died. My husband died unexpectedly at age 52. Although he had been ill with emphysema for a very long time, I did not admit the severity of his illness. We continued on with life as if it would continue forever. When my husband abruptly died, I had no plans in place. I had to search for a burial plot while my husband was on life support in the hospital intensive care unit. Although I knew he had very strong feelings about the subject, I could not remember whether my husband wished to be cremated.

JACQUELINE: My parents also died without plans in place when I was young. My siblings and I had very different ideas about what our parents wanted, and even different religious beliefs about their funerals. We were each so sure we knew their wishes. It meant so much to us to treat our parents with love and respect that we argued when we could have been there to comfort each other. It took us a long, long time to heal and finally grieve and become a family again.

So both Marilyn and I realized we were not alone. So many people don’t plan, don’t let their families know what they want, and family members undergo added stress and trauma at a time when they need to grieve. Hard decisions shouldn’t have to be made when people are suffering. We realized we could help people by finding ways to motivate them to do what had been so hard for us.

SARAH: Why do you believe there is such a hesitancy to discuss some of the end-of-life issues that you cover in LeaveLight? How does this lack of conversation serve as a detriment both to the person whose death is being discussed and those who will be left behind?

MARILYN:The reluctance to plan is largely due to the tremendous fear of death in western culture. Death is the enemy, a mistake. We don’t want to talk about it. Most people are simply afraid to face it. They prefer to think that it’s not going to happen to them. Consequently, seven out of ten people in the United States have not created a will, and polls show that 90 percent of people say they want to die at home, but only 20 percent do. Fewer than 10 percent of people actually use an advanced directive that specifies their wishes for health care should they become incapable of communicating them.

JACQUELINE: In some cultures people intentionally prepare for death throughout their lives with forgiveness and compassion so that by the time death occurs they are free from guilt and feelings of incompletion. LeaveLight helps readers consider what does stop them from planning, not only for themselves but to help the ones they love. We give readers a way to look at what will motivate them to plan by focusing on reasons they do want to do it. It could be that they want to establish care for people who depend on them, or leave life without regrets. Or they may have a deep wish to forgive and be forgiven. A free list of these possible reasons is available on our website. LeaveLight offers readers a way to bring their fears to light and work through them to complete their planning, especially in small, supportive LeaveLight Circles.

SARAH: Do you both bring a writing background to LeaveLight? Are you coming from the perspective of professionals in the field? Or, are there other aspects of your personal backgrounds that contribute to the content of the book?

MARILYN: I am a media artist, writer, instructional designer and personal historian. As a personal historian, I understand the value that recording life stories can bring to families. Many of the narrators I have interviewed over the years have since died. Their stories live on for generations to come and bring comfort to their family members still living.
My background in media and instructional technologies has helped form the design of LeaveLight into manageable steps that make it easy for readers to complete their planning.

JACQUELINE: I’ve been working with people throughout my career in the field of human resources. I am the Director of Transition Services at the Center for Volunteer and Nonprofit Leadership of Marin, providing professional executive recruiting for nonprofits. I enjoy helping people reach their full potential, and I think this is best done through good communication and healthy families. Marilyn and Wendy Dunne and I worked with the County of Marin to create and implement a Family Partnership Policy. With LeaveLight, people not only communicate their wishes to their families, but they reflect on their own lives. By putting plans in place in advance, people lessen their stress and worry about what will happen to their families and others they love. Then they can enjoy life, each other and each day as perfect and sacred.

Marilyn and I both share a belief in the power of gratitude, forgiveness, compassion and surrender to enliven and free our lives from regret and unhappiness.

SARAH: How long did it take to write this book? Is there information you can share with us concerning your writing method or how the book developed?

JACQUELINE: We spent over three and a half years writing LeaveLight. At first we planned only a practical guide with forms, but as we progressed, we realized the importance of addressing the emotional aspects of end-of-life planning.

SARAH: How did you publish your book? Tell me about your publishing experience with LeaveLight and what you learned from it.

MARILYN: We very quickly came to the conclusion that we would independently publish LeaveLight. We were aware of the difficulties of getting an agent and a publisher and the long lead times in sending a book through the traditional publishing channels. We did not want to spend our energies in that direction when we would end up marketing LeaveLight ourselves in any case, We had the technical expertise to independently publish, and in so doing, we retained creative control over our book and over its sales.

SARAH: Where is your book available? Do you have a Web site or blog where we can learn more about you or your book?

JACQUELINE: LeaveLight is available on Amazon.com, Barnes and Noble.com, and other online outlets, as well as through our website and blog.

SARAH: As far as marketing, do you do more online publicity or print/radio/TV promotion? Tell me some ways you have promoted your book.

JACQUELINE: Our marketing program is just getting started. If we could do anything differently, we would have started marketing earlier. We designed our marketing plan to include a website and blog. We write articles and make comments on other blogs about advance planning topics. Our certified facilitators reach out in their communities to sell the books and deliver the six-session circles. We enjoy being guest speakers, and we deliver short programs on LeaveLight.

SARAH: Do you have any future writing projects in the works, or any other work you will be doing associated with end-of-life issues?

JACQUELINE: We plan to add video testimonials to our LeaveLight website. Participants tell what they have experienced with their families and in their lives as a result of reading LeaveLight, participating in the Circles and completing their planning. These stories are very moving. We continue to update our blog with stories and video interviews of experts in end-of-life concerns and of ways that people relate to and celebrate their loved ones and life in general.

SARAH: Any other comments you would like to share about your book LeaveLight?

JACQUELINE: We encourage people to plan for their loved ones and live life to the fullest, every day. Please don’t miss a minute to forgive yourself and others, offer compassion, be grateful and surrender to the beauty all around us.

MARILYN: LeaveLight is not about dying—it’s about how we live and the legacy of love we leave behind for others.

SARAH: Thank you for giving us the opportunity to get to know you and learn about your book. I wish you both well in your journey with LeaveLight.