Die-alogue Cafe

Slowly but surely the message is getting out that encouraging people to plan for death can deliver good outcomes for everyone involved.
Hal Swerissen and Stephen Duckett [Gattan Institute, Melbourne, Vic.](What can we do to help Australians die the way they want to? Medical Journal of Australia 202(1) 19 January 2015) say: “A different service mix could better meet end-of-life (EOL) care needs for little additional cost.”
“Dignity, control and privacy are important for a good death. Choice over who will be present, where people will die and what services they will get matters.”
They write that: “Four reforms would facilitate a good death:
1st: we need more public discussion about the limits of heath care as death approaches;
2nd: people need to plan better to ensure their desires at EOL are complied with;
3rd: we need to ensure that these EOL wishes are followed;
4th: services for those dying of chronic illness need to be reoriented so that they focus more on people’s wishes do die at home and in homelike settings, rather than in institutions.
Swerissen and Duckett go on to set out costings including substantial savings to the health budget. Read the full story at: https://www.mja.com.au/system/files/issues/202_01/swe01580.pdf

Jean Kittson, is best known for her work as a comedian, but that does not mean she limits herself to making fun of life’s everyday situations.

“It’s an interesting fact that 70 per cent of us, at the end of our lives, will not be making our own decisions”, writes Kittson, in Talking about dying won’t kill you, Palliative Care Australia says. (SMH July 11, 2015).

She is not alone when she says: “I was not brought up to deal with the death and dying of family and friends”.

It was “William Pitt, the British prime minister, whose last words were: ‘I think I would like one of Bellamy’s veal pies’”.  And why not?  To die looking forward to one of life’s pleasures, must surely be a better ending than experienced by many.  Trouble was the family didn’t know.

“So talk about death”, says Kittson.  That way we just might end up bringing our families along with us for the final fling, and we won’t “go to the grave wearing a lipstick or an outfit we wouldn’t be seen dead in”.

Read the full story at:  http://www.smh.com.au/comment/talking-about-dying-wont-kill-you-20150711-gi8yhs.html

An email lobbed into our mailbox today.  From Elizabeth Knox at the Crossings Network it pointed her readers to a story by Libby Copeland, writing in The New Republic.  Who Owns Death? talks about the grip that the funeral industry has on the hearts and minds of Americans and how a small but growing band of people are challenging its domination. “The modern American funeral industry, with its rituals and its almost complete capture of the death process … would have appeared extraordinary to a woman in 1875,” said Josh Slocum, the executive director of the Funeral Consumers Alliance.   The current economic model for funeral undertakers is: “we take the body, we do things do it, and we sell it back to you,” as mortician-memoirist Caitlin Doughty, the author of Smoke Gets in Your Eyes, told Copeland.

It sounds very much like what is happening in Australia, except that our response is less well organised.  Asking the question: Who Owns Death? seems like a fitting way to end the financial year at Die-alogue Cafe.  Read the full story here:  http://www.newrepublic.com/article/122130/who-owns-dead

As it does every year, Sydney Writers Festival (SWF) dishes up some great speakers that inspire us to think more deeply about various issues. 2015 is no different. Our pick of the crop is Caitlin Doughty. Featured on ABC TV Q & A on Monday 18th May, Caitlin captured the attention of the audience with her witty responses to questions about what it was like to be fascinated with death from age 8 and her chosen profession of mortician at a Los Angeles crematorium. She has authored a book that we will review in a future post. Smoke Gets in Your Eyes and Other Lessons from the Crematorium is but one string to her bow. She founded a “death acceptance collective” called Order of the Good Death (see links) and hosts a web series, Ask the Mortician.

“She is refreshingly honest about what happens to a dead body and questions the financial and emotional costs of embalming,” writes Margaret Rice (Final acts on the way to a good death, Spectrum, SMH May 16-17, 2015).

She’s now on a mission to change attitudes about death and dead bodies by encouraging people to take a more active role in the funerals of their relatives. This link to the ABC provides further links to an audio on The World Today and a You Tube post on Radio National … http://www.abc.net.au/news/2015-05-21/mortician-caitlin-doughty-attitudes-death/6487914

It is National Palliative Care Week from May 25-31 and the theme for this years awareness week is Dying to Talk.  We are all encouraged to do three simple things: THINK, TALK and TELL.   One good way to get started is to gather family and/or friends (or workmates and colleagues), make a cuppa, have a meal and watch a 10-minute video to focus attention and provide some background information.  These might include: Marmadukes’s Story, about a 4-year old boy and his family; Bassam’s Story, about what it’s like to live with the knowledge that life is finite, or I Didn’t Want That, a powerful short film from Dying Matters UK, that shows the importance of making your end of life wishes clear.  Get started by logging onto: http://www.pallcare.asn,au

Bruce Lipton, in his publication The Wisdom of Your Cells, writes that: “The emerging new paradigm reveals that we are not here by random chance, we are here by an intention and purposeful design of Nature.”

Lipton contributes to conversations pondering the big questions that many of us ask:  1. How did we get here? – through a series of adaptive mutations that enable us to balance the environment;  2. Why are we here? – in the wisdom of the Native Americans: “We are here to tend the garden”;  3. Now that we are here how do we make the most of it? – learn to live in harmony with Nature and each other.

Basal paradigms shape the character and fate of civilization.  It is basal paradigms that specifically inform the truths accepted by civilizations in answering these three fundamental questions of human existence.

The awareness represented by these questions and answers show we are embedded within Nature and don’t sit above or to one side of it.

So we need a new story.  For it is what we tell ourselves and how we live out our story that will either hinder or help the next generation to live in harmony with itself and its natural world.

Survival at the personal and societal level “depends upon the choices we make, which in turn are totally dependent on our collective awareness, the beliefs by which we live.”

Survival relies on new life – the act of birthing at its heart – which relies on being in community. To remain in community, we need to create bonds. Following birth, while we are no longer physically attached to our mothers, we are certainly emotionally and socially attached. Our mother ship lets go with the severing of the umbilical cord and we are free to be our own person.

The act of dying was also one of being in community.  Just as a birth midwife attended to the needs of the expectant mother and child, so the death midwife ministered to the needs of the expectant person nearing death and their family.  The sense of community was ever present.  Attending to the physical and emotional needs of all those involved was a valued job – even if there was no financial reward.

Bruce Lipton, writing in the Honeymoon Effect points out that: “Human beings are not meant to live alone.”  And we would add:  Human beings are meant to die alone.

Not only are we dying alone in increasing numbers, we are being sent off alone.  We are choosing No Service No Attendance (NSNA) funerals.  While this adds up to increased profits for the funeral industry it produces questionable benefits for the grieving family.

Lipton tells us nothing new when he says: ‘our need to communicate is vital for our wellbeing’. There’s not much communication going on at a NSNA event. Just as birthing is about relationships so dying is about relationships.  Just as nurturing for the newly born contributes to their future health, the nurturing for the grieving family contributes to their future health.

Once again this is a reminder that we need to question our understandings and measures for determining how we do death.

Bruce Lipton is a cellular biologist and author of The Biology of Belief.

“Naked came we into this world and, with the exception of maybe a pacemaker and a few sad tattoos, we’re pretty much going out the same way.”  Neil Jameson (Newcastle Herald, 14 March 2015) has observed in Lives stuffed with stuff, that in the period between birth and death we make a mighty effort to acquire as many material possessions as possible, not fully realising that there will come a time when it all has to be off-loaded onto somebody else.  The sad commentary on the times in which we live, that many of the things we have spent a lifetime stashing away in the hope that our children will treasure them turns out to be very different. It’s a flawed belief. Much of what we place a value on, the next generation have little attachment to. The resulting fate of much of this stuff is landfill.

Just as we need to have a good think about the medicalisation of dying and the commercialisation of death, so we need to pay attention to the impact of all the goods and chattels accumulated.  Just as we are now moving to a system of leasing land for a burial plot so we could do the same with ‘possessions’.  Leasing would be a good start for all the things we convince ourselves we need.  Ownership would be retained by the manufacturer and products returned for refurbishing and re-leasing.  Fuji-Xerox does it with photocopiers so why not do it with other items as well.  Leasing or renting a coffin or casket seems like a great idea to us.  Why on earth would you want to pay hundreds, if not thousands of dollars, for a piece of furniture and then burn or bury it within days?  Neil Jameson goes one step further … “how about this: a casket made from recycled junk mail lined with flyers depicting everything your material heart desired.”  Paper mache would do the trick , and why not?    Sounds like a good topic and activity for a Die-alogue Cafe meeting.  http://www.theherald.com.au/story/2941672/neil-jameson-lives-stuffed-with-stuff/   and   http://www.firstpalette.com/tool_box/quick_how_to/papiermacheballoon/papiermacheballoon.html

This is the story that includes reference to a home funeral.  It is by no means the central theme and does not appear in the slide sequence until almost the end.  It does seem like the natural extension of what took place during this child’s short life.

Journalist Rena Silverman, reports how Martin Lehmann comes to terms with creating a photo story of his family’s babysitter, Birgitte (A Broken Heart, a Child’s Life (New York Times, Feb. 19, 2015) who gives birth to a child ‘with a defect that would disrupt the infant’s blood flow. Birgitte grappled with decisions, from having an abortion to allowing surgery after birth.’

It is time to forgo instant gratification in favour of the thrill of accruing real wealth (read health).   With the New Year now 10% gone it is a good time to reassess how we are tracking in terms of our goals for the year 2015.  Have we resolved to get our advance planning documents in order and a conversation with family about our end-of-life thoughts?  If so, are we still on course or have we slackened off, in favour of next month or even next year?

Noel Whittaker writing in the Newcastle Herald recently (In for a long exciting haul, February 5^th), reminds us “that the human body is not (naturally) wired for long term planning.  Our ancestors … dominant thoughts were purely about survival”.   “As a result we instinctively prefer an action with a fast pay-off to one with a long term result. The scientific name for it is hyperbolic discounting – it causes people to make choices that can lead to short-term pleasure, but long-term disaster”.   So this is a good time to consider what might be involved if we were to modify the way we think about investing in our long-term future well-being.

It has been said that, those who fail to plan, plan to fail.  Let this not be our way of living.  Resolve to be an ACTOR:

1. Action a plan
2. Consult independent sources to build a knowledge portfolio.
3. Take-steps to draft a plan the contents of which will include:
   1. Will
   2. Advance Health Care Directive (AHCD)
   3. Enduring Guardian
   4. Power of Attorney
   5. Advance Death Care Directive (ADCD)
   6. Estate disbursements (and Succession program if in business or with Trusts to manage).
4. Organise a family meeting,
5. Revise, sign and file it in a place that the executors know about.

This process is a great investment, from a health perspective (peace of mind), social perspective (improved family relations) and wealth perspective (save estate and remaining family thousands of dollars in reduced funeral and legal expenses).

It makes for a very persuasive point of view to face down our hyperbolic discounting nature and replace it with some foresight given substance with some forethought.   It is one of those gifts that can be given, reshaped and given again – gratifying to all parties and cause for a party for the dearly departed.

We thought our first post for 2015 ought to deal with our adequacy to manage our own affairs just like our great parents did in the good ole days.  Let’s talk about death and dying argues that it’s time for an open and frank conversation about:  • how death has become a lucrative industry in Australia, and   • how we, as citizens, can be active players on the field, rather than passive spectators from the sidelines.  See the full story here: Let’s talk about death and dying discussion starter