Hospice News S P RING 2 01 7
Rituals of Remembrance Honoring and Remembering Our Loved Ones
Sustaining Life: A Paradox Saving a Life Versus Ending the Pain
Denise Larson Hospice Social Worker
In thinking about our loved ones that have passed, our minds often wander to the special times we shared through the years. Some of the moments are times to smile and others are times to cry. An act of remembrance provides a symbolic connection to our loved one that can help us in the process of healing our hearts. This ritual of remembrance can help us to find meaning in our own lives as we move through our grief. Remembering our loved one in a special way acknowledges their death, celebrates their life and helps us search for new meaning in our own lives. Each remembrance becomes more meaningful when there is a connection between the person who died and the person left behind.
There are many ideas provided in books and on the internet that give suggestions on how to create an act of remembrance for someone we have loved and lost. Family and friends can provide a valuable support system as you create your ritual of remembrance. Some ideas to consider are listed.
Make a memorial scrapbook of items important to your loved one. Attend a remembrance service. Light a candle for your loved one on special occasions such as holidays, birthdays or another special day of the year.
Have a night of remembrance where you invite family and friends to a special meal and to share memories of the person you lost.
Purchase an ornament for the Christmas tree.
Name a star after your loved one.
Turn a favorite piece of clothing into a teddy bear.
Make a memorial bracelet to wear.
Create a photo quilt.
Purchase a memorial park bench and donate it to a place important to your loved one or you.
Frame a cherished garment. Plan an annual day of celebration.
Have a butterfly release. Visit the grave site; bring a gift to leave such as flowers or balloons.
Make a donation in support of a cause important to your loved one.
These are just a few of the many ideas to honor and remember your loved one. The ideas are only limited by your imagination. The act of remembrance that you choose provides an opportunity for you to honor and pay tribute to the loved one that you lost. Creating a symbol or ritual of remembrance may help you as you move through the process of grief and begin to heal.
Plant a memorial flower garden. Create a custom memory quilt from items of clothing. Plant a tree or flowering bush in your yard or a special location. Start a scholarship in honor of your loved one.
SUSTAINING LIFE: A Paradox Richard P. Holm MD
Several years ago, I was made aware of a young woman driven into a persistent vegetative state by a motor vehicle crash induced brain injury.
Sadly, she was still alive after years in a nursing home and her mother had a change of heart after all these years. The mother requested the doctor stop artificial hydration and let her daughter die a natural death. The force of this change of plans came face-to-face with a physician and a health system who were each reluctant to follow her directives due to perceived risk of a law-suit and legal liability. I believe, despite all the expressed wishes on the motherâ€™s part, the patient is still unconscious and alive on a feeding tube in the same nursing home. What can we learn from this sorrowful and antagonistic story?
Would stopping fluid feedings be more merciful than keeping her alive for years in a vegetative state? The paradox of fluid replacement meant to sustain life is that it can also prolong pain and suffering. In this case, there is likely a significant burden of suffering from severe muscle spasms, not to mention the consequences of total bed rest and complete dependency. Even if she were alert and trapped in a dysfunctional body, consider the suffering consequent to an inability to move or speak. In addition, consider the persistent anguish of the family members who are repeatedly forced to consider the wasting as well as the lost potential of this loved individual.
Would stopping fluid feedings cause her to suffer? Scientific experience shows us that if dehydration occurs during the dying process, the brain produces natural endorphins that reduce pain and provide comfort. This allowed, a human being will slip away gently over an eight to 12-day period. This is just like nature has done it for as long as humans have walked this earthâ€Ś that is until we interrupted the natural process less than a century ago by learning how to provide artificial hydration in the form of feeding tubes or intravenous (IV) fluids. Of course, artificial fluids have rescued many lives, lives that needed to be saved, but the challenge is in understanding when rescuing is futile and / or causes undue suffering and harm.
Is there a difference between not starting fluid feedings in the first place and stopping them? The AMA Code of Medical Ethics and the law of the land both state there is no ethical nor legal difference between not starting treatment and stopping. Any treatment, started to enhance health and diminish suffering, can be stopped, especially if treatment is no longer helping or is now causing harm.
Do I, as an individual, or someone acting on my behalf, have the right to ask for the tube to be removed? The American Medical Association’s (AMA) Code of Medical Ethics states clearly, “Physicians are to sustain life but also to relieve suffering; and where one duty conflicts with the other, then the preference of the patient or his representative should prevail.” Like the CEO of our local hospital recently said, “The person or the person’s representative should have the last say.” In this case, especially where sustaining life might cause suffering, the defined power of attorney (let’s say it was the mother) has the right to ask to have life support and feedings discontinued. Further, the physician should honor those wishes unless this is not consistent with the physician’s personal ethics. In that situation, the physician should transfer the patient to the care of another doctor. The same goes with the nursing home and their responsibility to find another facility to care for the patient if there is such conflict.
Of course, if there are multiple people arguing over who has power of attorney over this individual, then feeding tube nutrition would continue until the power of attorney is defined. This also goes for the emergency room situation when the ER doctor doesn’t have a clear direction from patient or family about resuscitation or not. Then resuscitation efforts would continue until futile. What is the most important lesson from this story?
You should all talk with your family in advance about your wishes regarding vegetative states and feeding tubes. This is the most important lesson. If they all know what your wishes are, they will more likely follow those wishes than if you had an iron clad, lawyer written, defined living will or power of attorney document. It might prevent a lot of suffering. Of course, if reasonable, you should define one power of attorney to make health care choices for you, and make a living will document with a lawyer, but it doesn’t outweigh the value of talking to your family. More information and forms are available online at www.brookingshealth.org/AdvancedDirectives.
Brookings Health System Hospice would like to acknowledge with appreciation the following donations (received January through March 2017): In Memory of Alfred Adrawis Thomas and Lori Krogman
In Memory of Mercedes Ahlers Virgil Ahlers
In Memory of Rod Vincent Thomas and Lori Krogman
Donation from Winsor Township Charity Fund
In Memory of Shirley Strande The Strande Family
NOT EVERY GIFT IS CASH
Donate 401(k) or IRA assets. If you are 70 ½ or older,
Cash is the most common gift to charity, but not everyone can give cash. Here are some ways you can create a legacy and support Brookings Health System Foundation in ways that don’t impact your cash flow or lifestyle.
you can transfer up to $100,000 per year from your IRA to charity and not recognize it as income.
Identify Brookings Health System Foundation as the beneficiary of a life insurance policy. Simply use a Change of Beneficiary form from your insurer.
Give a gift of stock. Your broker can transfer securities you’ve held “long-term” to Brookings Health System Foundation. Call (605)696-8855 to obtain account information.
Remember Brookings Health System Foundation in your will or estate plans. It just takes a simple designation in your will or trust and it’s easy to revoke if your situation changes.
BE AN ADVOCATE We encourage you to make a gift in honor of someone who made a difference in your stay or visit at Brookings Hospital, The Neighborhoods at Brookview, Arlington Medical Center, Volga Medical Clinic, White Medical Clinic, Yorkshire Eye Clinic, Hospice, or Home Health. You can honor a doctor, nurse, lab technician, housekeeper, hospice nurse, chaplain—any of our staff members. The Foundation will notify the staff member when a gift is given in their name and that staff member may then direct the money to any of the existing Foundation funds of their choice.
Phone: (605) 696-8855 email@example.com Learn more about how you can give at brookingshealth.org/Legacy
300 22nd Avenue Brookings, SD 57006 ADDRESS SERVICE REQUESTED
This is a recyclable product.
Hospice News is published by Brookings Health System. This publication in no way seeks to serve as substitute for professional medical care. Consult your physician before undertaking any form of medical treatment or adopting any exercise program or dietary guidelines.
We Extend Sympathy to the families of patients lost through March 2017: Evelyn Adee Mercedes Ahlers
Eleanor ’Je Deknikker Althea Ewing Leonard Feuerhelm Verl Hieb