The medicalization of dying, in hospitals, in extended care facilities and even in hospice, often leaves little room for the most human of experiences—intimacy. And yet being close to those we love—being able to touch and be touched, as well as having the privacy we need to express our feelings—are essential elements to living a good and wise death.
The sea change taking place in the popular culture, with regards to sexual minorities, people with disabilities, as well as seniors and elders, may not always be reflected in the way we care for those at the end of life. Conscious dying is virtually impossible if those around us are insensitive to our intimacy needs. And the truth is, this is just as pressing a concern for people in traditional relationships as it is for those in non-traditional relationships.
“Can’t you see I’m starving? For as much love as I get from you, I could be living on the moon. Are we ever going to resume our sex life? Because if I wanted to live like a nun I would have joined a convent. Your sex aversion is making me sick.”
I want to introduce you to my friend Holly.
She is 43 and a graphic artist. She had a double mastectomy three years ago and has been cancer-free since. She shares a home with her wife, Jean, and their teenage daughter, Annie.
A beautiful smile radiates from Holly’s full, mocha-colored face. Oodles of thick jet-black braids spring from her head as from a fountain gone mad. Her frequent laughter is like music, making her whole body dance and shake. However, her levity masks a somberness and apprehension.
She tells me: “I have become consumed with worries about getting sick again. My fears can turn into a paralyzing dread that takes days and sometimes weeks to shake. I know that until I can accept the possibility of my own death, I’ll never be able to embrace all the great things that are right in front of me.”
Later in our conversation, she lets me know she’s struggling with her body image. The mastectomy scarred her not only physically, but psychologically as well. “For a good six months after the surgery, I was so sick from all that poison, that the thought of sex of any kind made me nauseous,” she says. “I didn’t even want to have Jean in the same bed with me, and it was awful.”
Over time, the nausea diminished. Holly was able to resume some semblance of intimacy with Jean. They watched TV while holding hands, as long as it was not sexual.
A couple of months ago, however, Jean and Holly had a blowout. “We were screaming and yelling when she finally blurts out, ‘Can’t you see I’m starving?’” Holly recounts. “Jean tells me, ‘I have needs too, you know. For as much intimacy as I get from you, I could be living on the moon. Are we ever going to resume our sex life? Because if I wanted to live like a nun I would have joined a convent. Your sex aversion is making me sick.’”
The intensity of Jean’s outburst blew Holly away. She had completely forgotten about her needs. After the surgery, Holly didn’t feel like a woman.
When things simmered down, Jean could tell she wounded Holly deeply. But she knew Holly needed to address it.
Jean was right- Holly was starving too, but she was too afraid and ashamed to admit it. The pair made attempts to move past the status quo, but it’s not like the old days.
Holly wonders how she can make a gift of herself to someone if she’s not feeling much like a treasure. She still feels shame about losing her breasts. “I’m not a whole person anymore,” she says.
That’s where Holly is mistaken, and I jump in.
“Where did you lose your breasts, at the laundromat?” I laugh. “You didn’t lose your breasts- you had cancer, and they were removed to save your life. There’s no shame in that!”
It doesn’t sound like Jean thinks of her as “damaged goods,” and the attraction remains.
The couple needs to let their love heal Holly of shame and self-doubt.
Has Holly ever taken the time to grieve the loss of her breasts? Could she ask Jean to hold her while she weeps for what is no longer hers? “Share it with her,” I tell her. “Don’t carry this alone.”
Holly counters that her sex drive is non-existent.
The first couple of months after chemo and radiation, she experienced a weird feeling when Jean would attempt closeness. “It was like a bad acid trip,” she says. “I felt as though my body was there with her, but I felt nothing. I would lie there asking if I would ever feel normal again, and wondering how many more opportunities I would have to be with Jean before I died.”
Back then, Holly was fighting for her life. That fight is bound to alter a person’s perspective.
I suggest that she talk with Jean about her concerns. A neutral time- not during an intimate moment- is best. Then, Holly can speak freely without fear of Jean misinterpreting her comments as sexual rejection.
“But what if I screw up?” Holly asks. “If this somehow scars Jean for the rest of her life, I wouldn’t be able to forgive myself.”
Holly needs to reassure Jean that she is committed to working through this impasse. In return, Holly could ask for her patience. She needs to give Jean some sort of timeline- or Holly may put this off indefinitely.
“You didn’t lose your breasts- you had cancer, and they were removed to save your life. There’s no shame in that!”
I recommend they begin to explore what is possible now in their sex life together. Avoid comparison to the past. Keep the exploration simple. Don’t create a goal to be achieved.
They can start with cuddling and spoon breathing- Jean’s front to Holly’s back. They can match one another’s breathing pattern. First, Jean will try to match Holly’s breathing. Then, they switch positions. It’s the ideal place to start rebuilding a sense of confidence about being physically together.
Spoon breathing embraces could become more adventuresome. When Holly is feeling up to it, she can take one of Jean’s hands in one of her own and guide it over her body in a way that feels pleasurable and comfortable. This will be a very effective way of reestablishing a threshold for what is possible now, as well as moving forward.
“Keep these exercises playful and honor your limits,” I remind Holly- and ask her to let me know how it goes.
“Folks frustrated by what life throws at them are often filled with rage and self-pity.”
I got an email recently from a 58-year-old man who lives in San Diego. His name is Doug, and this is what he had to say:
“Hi, I need some help. I had my prostate removed due to prostate cancer. I feel I have lost my manhood. I don’t experience erections anymore. Can you recommend something to help me?”
I don’t think Doug is dying, not actively dying anyhow, but he sure is experiencing a profound sense of loss — the death of his sexuality. Or at least the death of the sexual expression he was accustomed to before his radical cancer treatment.
Another truly uncanny thing is that in the same week I heard from Doug, I have received distressing emails from three others who were at their wits end because life had dealt them a crushing blow. While each person who wrote me had a very different presenting problem, all were experiencing a similar “death” as Doug’s. I heard from a woman in Toronto who is recovering from a radical mastectomy. I heard from a guy in Dallas who had just started a recovery program for his serious meth addiction. A young wife and mother in North Carolina whose husband and father of her two kids had returned from Afghanistan an emotional and physical basket case. And now Doug.
It is astonishing that, despite the dramatic differences in each person’s life story, all of my correspondents reported pretty much same thing. Each felt less than whole, disconnected from their sexuality and devoid of any real intimacy or meaningful sexual outlet. It is so amazing how, despite our unique individual difficulties, there is often a universal response to life’s troubling complexities, particularly as it applies to who we are as sexual beings.
When I wrote back to Doug, I wanted to empathize- but also encourage. Regaining a sense of sexual-self after prostate surgery, or any of the other problems I mentioned above, is an arduous- but rewarding task.
Massage will soothe so much more than the jangled nerves and disrupted muscle tissue caused by radical and invasive surgery. It gives the one doing the touch a renewed sense of him/herself as a pleasure giver- so very important to us all.
Hey Doug, I’m so glad you wrote to me. I’m sorry to hear of the problems you have been having since surgery, but I think I have a few tips to offer you.
Considering your ebbing self-confidence and zero libido, I suggest that you begin your rehabilitation by connecting with others similarly challenged as you. In your case, that will probably be other men living with and through prostate cancer. More likely than not, they will be a lot more sympathetic to your issues and attuned to your predicament than even your closest friends and family. Sometimes, people who have yet to experience a life threatening illness or a disfiguring surgery don’t have a clue about how to interact with those that have. It’s not their fault; it’s just the way things are.
I suggest looking into a support group, if you haven’t done so already. Once you make that connection, you will find that you are not alone. The other men in the group will be experiencing many of very same things you are. To my mind, it’s a whole lot easier to face and handle life’s difficulties when surrounded and supported by others. That being said, I want to give you a heads-up about support groups, particularly if you have never participated in one before.
Each support group has its own personality and dynamic. If the group is not lead by a skillful facilitator, it will no doubt degenerate into a bitch and gripe session. No surprise there, I suppose. Folks frustrated by what life throws at them are often filled with rage and self-pity- a lethal combination. A group like this, you should pardon the pun, will be a death trap. If you find yourself in such a group- leave it and look for another. A successful group, on the other hand, will be transformational; it will challenge and motivate as well as support you.
Another caution: beware of the lowest common denominator. If you are in a prostate cancer group, you can be certain that every man in the group has sexual issues he wants to talk about. Unfortunately, few of these men will be so bold as to admit that. It is how “us guys” are conditioned to behave. We can endlessly brag about our sexual exploits, but, God forbid, we ever seriously discuss our sexual issues. I have plenty of experience leading these sorts of groups and I can assure you, I have to drag the sex stuff out of the participants until they get the hang of it. Then, I can hardly get them off the topic. If you find yourself in such a group, I hope you will take the lead and help break the ice, so to speak. You will do everyone- yourself included- a huge favor.
Next, I suggest that you try connecting with people on a sensual level as opposed to a sexual level. For example, I firmly believe in massage as the best way to accomplish this. Think about it. Imagine the good you will be able to do for others, as well as yourself, with therapeutic touch. In my book, therapeutic touch also includes sensual touch.
Massage will soothe so much more than the jangled nerves and disrupted muscle tissue caused by radical and invasive surgery. It gives the one doing the touch a renewed sense of him/herself as a pleasure giver- so very important to us all. When you receive the touch, it will begin to reawaken sensory connections you thought were lost for good. Your libido, as well as your erection, will surely bloom again. I promise. To keep that erection going once it starts, I encourage you to use a penis ring. If you don’t know what that is, do an internet search. It is a brilliant, low-tech solution to erectile dysfunction, which happily doesn’t involve pharmaceuticals.
If you feel your massage skills aren’t up to par, why not take a class or workshop in massage? You might want to look to something like the Body Electric School Of Massage. They have loads of training options and there are chapters all over the world. In their modality, learning is a hands-on experience. What could be more liberating than that?
If a class is a bit too intimidating at first, you might consider purchasing a book on massage. I have two exceptionally good ones in mind. The first is: Male Erotic Massage, by Ray Stubbs, Ph.D. This is a holistic approach to bodywork, including the sexual and the spiritual aspects of Male Erotic Massage. There are more than 200 photographs in this volume that reveal both massage techniques and the beauty of the male body embracing the male body. The strength, the joy, the gentleness, the ardor, the tenderness, the equanimity and the pleasure — they are all included.
The second title is: Erotic Massage, The Touch of Love also by Ray Stubbs, Ph.D. This is a more inclusive volume of erotic massage. It describes long, flowing strokes for the whole body, including female and male genitals. By the way, this was the very first massage book to explicitly illustrate genital massage. The techniques described are simple and easy. It is superbly illustrated, and the text is both tender and playful.
Finally, your gift of massage is the ideal way to connect with another human, be it a friend, a partner, lover, or even a relative stranger. Your touch can be either seductive or non-seductive, or maybe a little of both. You can count on this purposeful touching to open new doors to what is possible for you now, post surgery. The mistake that many people make at this point is to compare what is going on for them now to what they were used to before their diagnosis and/or surgery. That won’t do. You now have a new normal. Find out what it is, embrace it, and then slowly stretch those boundaries. You will discover new pleasures, both subtle and profound, as you give as well as receive touch.
I encourage you to push beyond the isolation I know you are feeling, Doug. Purposeful touching, like massage, will change your perceptions about sex, sensuality and intimacy. It will, more likely than not, revitalize the arousal phase of your sexual response cycle. I know this can happen. I have seen it happen. And now, Doug, it’s your turn to make it happen!
“Now there’s a million dollar idea! Someone ought to write a no nonsense instructional booklet for the men folk, one that we would automatically recognize and understand. One that would help us, step by step, through the harrowing experience of having a person we love at death’s door.”
My first Relationships and Intimacy column was titled “It Never Entered My Mind.” It recounted a conversation I had with a woman who told me of the very painful personal experience she had while attending the death of her beloved husband in a Midwestern hospice. Apparently, it struck a chord with some. I don’t get a lot of correspondence from people who read my columns, but every now and again the odd email or letter will show up, and I am reassured that my efforts haven’t been for naught. I love when that happens.
Not long after that first column appeared, I got an email from a fellow who may have seen it. He didn’t reference it directly, but it would have been quite a coincidence had he not. This fellow wanted some practical tips on how he might broach the subject of sex with his wife who had been recently diagnosed with ovarian cancer.
The man’s name was Alex. What struck me most about his message was his manner. In typical male fashion, he got right to the point.
He even laid out his questions in bullet points- a very typical “man thing” to do. Even though he made no mention of his anxiety, I could easily tell he was supremely worried that he might fail his wife in some way during her hour of need. His email reeked of the kind of performance anxiety I so often see in my sex therapy private practice. His wife’s disease process shook his confidence to the core.
He was looking for a “how to.” You know, like the kind of owner’s manual one would find included in the box of a new power tool. I thought to myself as I read his email- Now there’s a million dollar idea! Someone ought to write a no nonsense instructional booklet for the men folk, one that we would automatically recognize and understand. One that would help us, step by step, through the harrowing experience of having a person we love at death’s door.
SAFETY INSTRUCTIONS AND INSTRUCTIONAL MANUAL WARNING
IMPROPER OR UNSAFE use of this power tool can result in death or serious bodily injury. This manual contains important information about product safety. Please read and understand this manual BEFORE operating the power tool. Please keep this manual available for other users and owners before they use the power tool. This manual should be stored in a safe place…
There would be lots and lots of diagrams and symbols and even a schematic or two. Of course, there would be pages and pages of dos and don’ts.
NEVER touch moving parts.
NEVER operate without all guards in place.
ALWAYS use the right tool for the job.
NEVER use a power tool for applications other than those specified.
NEVER use a tool that is defective or operating abnormally. ALWAYS use protective eye gear.
Alex’s message was a manly cry for help. It was clear to me that even though he loved his wife dearly, he had some deep misgivings about his capacity as an effectual lover- even under the best of circumstances. Now that his wife had undergone radical gynecological surgery, he was even more adrift than ever.
It didn’t help that Alex couldn’t or wouldn’t use even medical terms regarding his wife. I couldn’t tell if he didn’t know the vocabulary or if he was just too embarrassed to type it. When words failed him, he used that universal euphemism, “down there.”
I had my work cut out for me. I was tempted to do some remedial sex education. I could have included some diagrams and symbols and even a schematic or two. In the end, I decided to forego an elaborate response that might have overwhelmed him. I decided to answer, as succinctly as I could, each of his questions.
“I don’t know what your wife wants or needs. But there is a mighty good way to find out. Ask her!”
“Discussing sexual concerns in a crisis is never going to be easy, especially if you don’t have a history of doing so.”
“Maybe that’s a question you and your wife could bring to her oncologist.”
“Yes, I can assure you that both the surgery and the chemo will affect your wife’s interest in sex. Don’t take it personally.”
I answered all the questions he posed as best as I could. Then I added a personal note.
“Alex, my friend, I suggest that before you approach your wife with this discussion- you might do a little homework. Maybe if you knew what it is you are looking for in your intimate relationship with your wife at this time, at least one of you would have a leg up on the upcoming conversation.”
I directed him to my book, The Amateur’s Guide To Death And Dying; Enhancing The End Of Life, not because I wrote the blasted thing, but because it contains an entire chapter on sex and intimacy concerns for sick, elder and dying people and their intimate partners. It’s as close to a “how to” guide as I’ve ever seen. I invite readers to consider the following: Some Questions about Sexuality and Intimacy.
I posed five simple questions to help my readers focus their attention on their own sexuality and intimacy needs.
1. How important is sexuality in your life?
2. Is there’s a difference between sexuality and intimacy?
3. Do you have a range of options in which to experience your sexuality? If yes, what are some of them?
4. How well are you able to communicate your needs for sex and/or intimacy to your partner(s)? Are there any specific issues that get in the way of asking for what you need?
5. What are your biggest concerns about your sexuality as it relates to your disease, aging and/or dying process, or the disease, aging and/or dying process of your intimate partner?
I had great confidence that if Alex took my advice and answered these questions honestly, he would be ready to approach his wife to find out what she wanted and needed from their intimate life post diagnosis and surgery. I suggested that once he had answered the five questions, he could offer her the opportunity to do the same. Once they had both answered the questions, they could set up a time to discuss their answers.
While this approach wouldn’t make the experience any less daunting, at least they would have a roadmap to get them where they needed and wanted to go.
“I would like to propose that the end of life be sanctioned as a culture war-free zone.”
Perhaps you’ve been following the heart-wrenching story that’s been coming out of Ohio this summer. It involves the odyssey of John Arthur and his partner of 20 years, Jim Obergefell. John is in hospice care; he is in the final stages of amyotrophic lateral sclerosis, or ALS, a progressive neurological disease. ALS robbed him of his ability to walk and talk, and very soon- it will kill him. John and Jim wanted to marry before John died, but Ohio prohibits marriage between same-sex partners. Their only option was to travel to another state.
When the Supreme Court struck down DOMA (the Defense of Marriage Act), Jim and John knew they had a very brief window of opportunity to codify their relationship in the same way as any loving, heterosexual couple might. They chose to travel to Maryland to marry, but getting there and back would be a daunting task. John needed a medical transport plane that could accommodate his stretcher- a trip that would cost some $13,000. Undeterred, they appealed to friends and family for help. Their appeal was met by enormous generosity, and in a matter of days, they had raised the necessary funds.
By mid-July, all was ready. Jim, John, a nurse, two pilots trained in emergency medicine and John’s aunt Paulette- an ordained minister- boarded a Lear jet in Cincinnati for the short flight to Baltimore. The marriage ceremony took place on the airport tarmac and lasted only seven and a half minutes. A champagne toast followed. After just 56 minutes on the ground, they were headed back to Cincinnati. A triumph of the human spirit, I dare say.
John and Jim’s marriage license could change many things about John’s end of life care and the disposition of his estate. Health insurance, for example, might be less of an issue now that they are legally married. Their marriage license might very well open doors to other legal remedies for thorny problems like Social Security benefits, income and estate tax, probate concerns and the Family Medical Leave Act. But, none of this has been tested. No one yet knows what federal benefits a same-sex couple might qualify for if they live in a state that doesn’t recognize their marriage. What are the implications for a couple- that leaves their state of residence that bans same-sex marriage- to marry in another state that allows it? It will be years before this is all sorted out.
Within days of this headline-grabbing wedding, a federal judge in Ohio ordered state officials to recognize Jim and John’s marriage. When John dies, his death certificate must acknowledge Jim as his spouse, so stated the decree. However, just one day later, Ohio Attorney General Mike DeWine appealed that judge’s ruling. The legal limbo thus continues. John won’t live to see the end of this.
I can’t help but think about how this culture war is further complicating John’s already difficult process of dying. I’ve had to ask myself: What about the professional people who attend John as he dies? Surely, each of them has an opinion as to the morality and the legality of Jim and John’s marriage. Will they be able to do their job while respecting the union and its privileges without letting their personal beliefs get in the way? A tall order that!
Despite new marriage equality laws on both the state and federal levels, the issue of compliance remains an open question. In the state of Washington, for example, we have had marriage equality since late last year. However, there have been several high-profile cases in which wedding vendors have refused service to same-sex couples. A florist would not- on religious grounds- provide flowers to one of her long-time customers, a gay man, when he asked her to supply arrangements for his wedding. Similarly, some wedding officiants, caterers and venue managers- because of their religious scruples- have also refused service to same-sex couples. Even some state registrars wanted an exemption, on religious grounds, from providing same-sex couples a marriage license. While these things are disconcerting and bothersome, they are not a matter of life and death. One can always find another florist or caterer, right? The same cannot be said of palliative and hospice care.
Can a doctor, pharmacist, nurse, social worker or attendant deny care or respect for the intimate relationship of one of their patients, on religious grounds? Can a parent or other family member interfere with the care of a dying relative, or usurp the rights of a dying person’s spouse simply because the spouse is of the same gender as the person dying? Right now, I believe, the answer is an unqualified “yes.”
That’s why I would like to propose that the end of life be sanctioned as a “culture war-free zone.” Dying is hard enough without having to worry about who will be honoring whom and what as we die. I believe that we all should be offered a refuge from such worries at the end of our lives. If the culture wars must continue, let them rage somewhere other than where our life, or the life of someone we love, is ebbing away.
“Though we may be sick, even sick to death, we don’t stop being human. And our desire for the intimate connections we have with those we love remain intact until we die.”
Let me tell you how the conversation started. She said, “It’s hard to talk about this, but I need to tell you what happened.”
Rebecca is 68 years old. Her husband of nearly a half century, Jim, age 72, is in a Midwestern hospice. He will die very soon. Rebecca told me that she and Jim were blessed with a marriage of good health. In fact, the only time either was in a hospital was for the births of their three daughters. However, six months ago, Jim began to complain of a persistent stomach ache. His interest in food evaporated. He began to lose weight, and he felt tired most of the time. He chalked it up to stomach flu at first, but the symptoms just wouldn’t let up.
Five months later- past the initial visit with his family doctor, the blizzard of tests, the arrangement to see an out-of-state oncologist and more tests- Jim and Rebecca arrived at a day of reckoning.
“Jim, I’m afraid your cancer is inoperable,” his oncologist said. “We could try an intensive campaign of chemotherapy and radiation to slow the growth of your tumors, but that’s about all that is humanly possible.”
The doctor’s verdict hit Jim and Rebecca like a semi. They wisely decided to forego the chemo and radiation and opted for as much quality of life that divine providence would afford them. A month or two- maybe.
“There is little time for Jim to even say goodbye to our daughters and their families, all of whom live out of state,” Rebecca told me, as she recounted Jim ’s last few days at home. “Our house is not set up for the kind of care Jim was going to need, so we looked to hospice.” Tears pooled in Rebecca’s eyes. “I feel like I am on a runaway train heading, at top speed, for a derailment. I am terrified and helpless.”
She continued on, and the conversation became more personal.
“Jim and I have always been close, and I don’t think we spent more than a few nights apart in 46 years of marriage,” Rebecca said. “We’ve always been very affectionate with one another, even in public. Our friends used to kid us about behaving like newlyweds- they would joke and say, ‘Hey, get a room!’ I think they were all secretly jealous.”
Rebecca is now spending all her waking hours with Jim at the hospice, which is nothing more than a glorified hospital ward. She tries to make the best of it. She
brings linens and towels from home, as family pictures and fresh-cut flowers fill Jim’s room. They hold hands and reminisce when Jim isn’t zonked out on morphine. When he is asleep, Rebecca holds his hand and prays.
Jim had a terribly bad spell last week. He was uncomfortable and agitated, and Rebecca didn’t know what to do. She did the only thing she could think of, she told me. Exactly what she said she would have done if the couple were at home.
“I kicked off my shoes, took off my sweater, and climbed into bed with Jim. He was lying on his side, so I slid one of my arms under his neck and I draped my other arm over his abdomen. I nuzzled his neck. I could actually smell him, like I remember him smelling before the hospital odors dominated. In a matter of minutes my embrace calmed us both. It was such a beautiful moment, I’ll never forget it.”
Unfortunately, another reason Rebecca won’t forget that embrace is because one of the hospice nurses barged in the room.
“The nurse, hands on her hips like some schoolmarm, face aglow with disapproval, glared at me,” Rebecca said. “She demanded: ‘What do you think you are doing? We can’t have this sort of thing in here. I’ll have to ask you to leave that bed immediately.’”
You would have thought the two were caught in some indecency. Rebecca stammered for words to explain, but no words came out- only a groan. She was so ashamed, beet-red with embarrassment. “It took me a few moments to untangle myself from Jim and find my footing on the floor,” she said. “Luckily, Jim slept through the whole thing. Bless him.”
Tears streamed down Rebecca’s face. “It never entered my mind that cuddling with my dying husband, soothing and comforting him, might be interpreted as something inappropriate. When the nurse finally left the room, I hung my head and wept.”
This is a cautionary tale; though we may be sick, even sick to death, we don’t stop being human. And our desire for the intimate connections we have with those we love remain intact until we die.
So many of us are thoughtless about the intimate needs of those around us. Is this a sign of our culturally induced unease with sex? Probably. But when our thoughtlessness impacts on the lives of those incapacitated, that disregard can be devastating. Regardless if our neglect is careless or intentional, the injury is the same.
Those of us who care for and attend sick, elder and dying people need to be particularly vigilant to our prejudices and discomfort around sex, sexuality and intimacy. Jim’s thoughtless nurse compounded Rebecca’s grief and anguish with guilt and shame. This professional woman should have known better. She violated
her patient’s privacy and then shamed her patient’s wife for an innocent act of loving care. And for what?
I believe we ought to afford all people, especially those incapacitated, a modicum of privacy. I believe that personal privacy should be part of every patient’s bill of rights. Curiously enough, the privacy of our medical records takes precedence over our own personal privacy. What a strange world in which we live.
Richard Wagner, M.Div., Ph.D., ACS
Richard is psychotherapist/clinical sexologist in private practice since 1981. He lives and works in Seattle, WA.
He is the author of The Amateur’s Guide To Death and Dying; Enhancing the End of Life.
He has been working with terminally ill, chronically ill, elder and dying people in hospital, hospice, and home settings for over 30 years. He facilitates support groups for care-providers and clinical personnel, and provides grief counseling for survivors both individually and in group settings.
He founded Paradigm Programs Inc., an innovative nonprofit organization, as an outreach to and resource for terminally ill, seriously ill, elder and dying people.
He often speaks in the public forum on policy issues related to religion, human sexuality, aging, death and dying, living with chronic illness, and moral development.