LGBT Seniors Fear Discrimination from Caregivers
Posted on Monday, July 1st, 2013 at 12:00 pm by Life Matters Media
Dozens of seniors and medical providers crowded into the Unitarian Church of Evanston, Illinois Saturday to watch “Gen Silent,” a critically acclaimed 2011 documentary highlighting the fears many seniors in the LGBT community have about end of life care.
Directed by Stu Maddux, the film chronicles the lives of six seniors living near Boston. They go back-and-forth recounting their experiences growing up during the onset of the gay rights movement and sharing their present struggles– ranging from fears of abuse from long-term care providers to judgmental caregivers and family members.
“When someone’s facing the end of life and feeling alone and isolated it’s incredibly sad,” said palliative care physician Catherine Deamant, a member of Chicago’s End of Life Care Coalition. Many in the LGBT community are afraid to show their “true selves” to caregivers for fear of bullying, she said, and long-term care facilities tend to overlook the individual.
“Many who won the first civil rights victories for generations to come are now dying prematurely because they are reluctant to ask for help and have too few friends or family to care for them,” according to the film’s website. Oppression from the years before the Stonewall riots continues to linger with those in the film.
The audience was clearly moved by the hour-long film, with many wiping their eyes or shaking their head with disapproval at some of the film’s more emotional moments. “I find it very frightening what lies ahead of me,” one man shouted out during the discussion. “Is this another reflection of how we handle the elderly? Why should it be different for any other group?” a woman asked.
The film, similar to the 2012 Oscar-winning drama, “Amour,” did not shrink away from showing the hard truths of aging, including scenes of hospitalization and loss of strength. “I think they saw the full humanness of the people in the film– they weren’t one-dimensional,” Deamant said.
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Duty of Physicians to Inform Patients of Hospice, Palliative Care
Posted on Saturday, June 1st, 2013 at 1:11 pm by Life Matters Media
Physicians have an ethical duty to inform their patients facing end of life about hospice and palliative care services, said Dr. Frederick Smith, director of clinical ethics at North Shore-LIJ Health System.
Smith’s presentation, part of the University of Chicago’s second annual Conference on Medicine and Religion, criticized the choices of many physicians who urge their patients to continue with more aggressive, painful treatments instead of more comfortable end of life care. Drawing inspiration from Judaism, Christianity and Islam, Smith suggested hospice and palliative care are compatible with religious teachings about death and pain. “A central function of religion is to provide meaning and consolation,” he said.
There are two things a failing patient needs to accomplish the “work of dying”: consciousness and time, Smith said. Dying allows patients time for reflection about life and opportunities for reconciliation. “Jesus wants his followers to seek reconciliation,” Smith said, noting the Lord’s Prayer.
“The Prophet Muhammad placed great value on forgiving the poor man’s debt,” Smith said. “The sacred books of the three great traditions, which originated with God’s call to Abraham, summon their adherence to a righteous life, comprised with loving adherence to God and honorable treatments to family, neighbors and even strangers. They teach that death is not the end.”
Hospice is most often used when curative treatment is no longer effective and a terminal patient is expected to live about six months or less. Palliative care is treatment that enhances comfort and improves the quality of life for patients. When deteriorating persons are not allowed time to begin the “work of dying,” they are more likely to leave feuds and conflicts unresolved, often carried on with the next generation. ”Feuds should not be taken to the grave,” Smith said.
One-third of hospice patients are too frail to begin the “work of dying,” because they are too frail, Smith said. They are transferred to hospice too late, only after aggressive treatments fail. Medicare reimburses for hospice care for up to six months, with extensions for failing patients who continue beyond six months.
Findings published in the Journal of the American Medical Association show hospice is often a last resort.
“Clinicians frequently ignore conversations about the likelihood of survival. If patients with life ending conditions truly knew the end was coming, would not it be better to take advantage of hospice?” Smith said.
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What is a life worth?
Posted on Thursday, May 30th, 2013 at 2:38 pm by Life Matters Media
Geriatrician argues against bias against the aged and ill
Physicians caring for the elderly and for those nearing the end of life cannot be effective patient advocates until they confront their own deep and widespread prejudices, said geriatrician James Wright at the University of Chicago’s Conference on Medicine and Religion Wednesday.
Wright’s presentation, “The Courage to be a Geriatrician,” examined the bias held by many towards those lacking in independence, particularly those residents of nursing homes. “Most of us share the same prejudice, that life is of less value when lived in dependency,” Wright explained. “We are in a tradition that cultivates freedom, independence and productivity, and that is what we give value.”
“We live in an era of meaningless- now that we no longer fear the sword, plague, even hell, we fear meaningless,” Wright said.
This prejudice thus serves as a blockade to administering comprehensive care to some of society’s most vulnerable- the oldest and most infirm. Medical professionals, those in geriatrics especially, must experience a shift in mindset from valuing life based on independence and instead towards seeing innate human value. The oldest and sickest are long divorced by age and ability from past functions, Wright said, but their lives remain valuable. That value does not stem from any thing they once did.
Prejudices manifest, Wright said, when doctors make quality of life assessments. His research demonstrates that when simultaneous assessments of life quality are made by both physician and patient, the patient almost always scores his or her quality far higher than the physician. “These devaluations matter,” he said.
The discrepancy, Wright argued, arises out of the drive of younger, working people towards self-affirmation. We often think, he said ‘‘I am not only alive, but my existence has meaning.’’ This quest for meaning is why the able-bodied join larger movements- political, civic or social. These movements give us worth.
“We live in an era of meaningless- now that we no longer fear the sword, plague, even hell, we fear meaningless,” he said, and this fear inhibits proper care of those we judge to have none.
Wright pointed towards the leaders of the Protestant Reformation as ones who can teach medical providers intrinsic human value. “All beings have equal value not because they earned it, but they were made that way by God, the source of all value,” Wright said. Both Martin Luther and John Calvin agreed that all of us, as humans, are not good enough, and fall short of our own expectations. However, God who loves without condition.
“We are enough as is,” Wright said, “and that gives us courage to be not as something greater.” The most successful providers see all life as equally acceptable and valuable, simply because that life is human.
“All people are created equal and remain equal throughout the course of their lives,” Wright concluded. “Only with this conviction, can we truly be trusted to value and care for the elderly in a way we all deserve.”
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Switching Roles at the End of Life
Posted on Thursday, May 30th, 2013 at 8:21 am by Life Matters Media
A physician watches his father die
As the Chief Medical Officer of Vitas Innovative Hospice Care, Dr. Barry Kinzbrunner, an oncologist and palliative medicine specialist, has cared for the terminally ill and their families for decades. But it wasn’t until the death of Kinzbrunner’s own father this January that the physician and rabbi said he truly came to understand the end of life experience.
In a talk entitled “Caring for My Father as He Died,” Kinzbrunner outlined the processes millions of Americans experience each year- watching the slow decline of a close loved one. He delivered his personal account at the University of Chicago’s Conference on Medicine and Religion Wednesday.
Kinzbrunner’s father suffered from progressive Parkinson’s disease at the time he broke his shoulder this winter. That fracture set off a series of events that led to death in a hospice facility. Kinzbrunner’s mother, siblings and children kept a vigil at the bedside for twelve hours prior to his father’s death, a time period Kinzbrunner called “the longest twelve hours in my life.” The difficulty of such a vigil, he said, was one he had not appreciated in his role as a physician- often coming and going from patient rooms in the busy course of a doctor’s day.
When he believed his father had taken his last breath, Kinzbrunner said he rose to check the pulse of his father’s carotid artery. However, he quickly retracted; Kinzbrunner called for a nurse, noting it was not his role to declare his father deceased.
In his personal recollections, Kinzbrunner focused on the often mundane details to which he had to attend to comply with his Jewish Orthodoxy. Each day he visited his ailing father, he wore an old shirt; in the instance his father were to die, he did not want to be clad in a newer, expensive one for “keriyah-” the rending of garments that is the most striking Jewish expression of grief.
Kinzbrunner shaved meticulously each morning following his father’s fracture- were he to die, Jewish law prohibited the use of a razor among the mourners for thirty days after a death. This January marked the first occasion in which Kinzbrunner wore a beard.
On his last trip to visit his father, Kinzbrunner stopped at a 24 hour Walgreens to purchase nail clippers, as trimming nails is prohibited during the sheloshim- the first thirty days of mourning.
Attending to these details and the often complex processes involved in end of life situations, Kinzbrunner said should be discussed more often among medical providers. “I was more comfortable in my role as a doctor than in my role as a son,” he said.
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Vermont votes to allow "Death with Dignity"
Posted on Tuesday, May 14th, 2013 at 5:10 pm by Life Matters Media
The Vermont House approved a measure allowing physicians the ability to prescribe life-ending medications to some terminally ill patients seeking to end their lives. Vermont is set to become the fourth state allowing the legislation known as ”Death with Dignity,” following Oregon, Washington and Montana.
The Patient Choice and Control at End of Life Act awaits approval from Gov. Peter Shumlin, a Democrat and supporter of the bill.
“By a 75-65 roll call vote, the House approved a bill largely that copies a law passed by Oregon voters in 1997 for three years and then shifts to a system with less government monitoring,” The Associated Press reports.
This marks the first time this type of legislation has been moved to passage by a legislature. With safeguards similar to the Oregon bill, patients seeking the prescription barbiturates must first state their intentions three times- once in writing. A second opinion from a physician indicating a patient has less than six months to live and proof of sanity, are mandatory. Patients must wait 48 hours before filling the prescriptions.
“It’s an important step for terminally ill Vermont patients,” Dick Walters, president of Patient Choices-Vermont, said after the vote. “It’s a big step forward for the region and for the country as a whole,” the AP reports.
Come 2016, changes advocated by some of the state senators seeking less government involvement during the process will go into effect, including less monitoring from physicians.
“It’s huge,” said lobbyist Michael Sirotkin, who for years has been involved with the issue in Vermont. “I think it’s going to have a major effect on other states’ willingness to vote on this,” he told USA Today.
But not all lawmakers approved of the bill’s passage. ”There can never be a dignified death using a handful of pills or a lethal cocktail,” said Rep. Carolyn Branagan, a Republican from Georgia, VT.
Other opponents were concerned about the radical changes the bill underwent while in the Senate. ”We are passing a bill that has not been vetted,” said Rep. Paul Poirier, an Independent from Barre. “Do we want to pass a bill … just accepting 100 percent what the Senate did overnight?”
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