Though it has brought advanced care planning to a remarkable number of people, Respecting Choices has encountered some resistance. Britt Welnetz, the organization’s business development consul­tant, said that she is often asked whether a nonphysician facilitator can effectively discuss medical decisions. She explains that the standardized, patient-centered conversation leads to an overall level of patient satisfaction.

Others ask if the Respecting Choices model can work in a community that’s more diverse than La Crosse. Research indicates that it can. The Respecting Choices program was implemented in a hospital in Mil­wau­kee, and the use of advance directives among racial and ethnic minorities in­creased substantially from 25.8 percent to 38.4 percent. Research suggests that it’s knowledge of advance directives, regardless of race and ethnicity, that leads to their use.

The advance care planning facilitator model has gained acceptance both nationally and internationally. Respect­ing Choices has trained more than 10,000 facilitators, as well as nearly 600 instructors and nearly 30 faculty members who can implement system-wide changes. There are facilitators in 47 states in the United States, and Respecting Choices is the national standard of care in Singapore and Australia; the program is also the model for an $8.5 million European Union study of advance-stage cancer patients and end-of-life care.

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An estimated 2.8 million older adults in the United States meet the criteria for alcohol abuse, and this number is expected to reach 5.7 million by 2020, according to a study in the journal “Addiction.” In 2008, 231,200 people over 50 sought treatment for substance abuse, up from 102,700 in 1992, according to the Substance Abuse and Mental Health Services Administration, a federal agency.

While alcohol is typically the substance of choice, a 2013 report found that the rate of illicit drug use among adults 50 to 64 increased from 2.7 percent in 2002 to 6.0 percent in 2013.

“As we get older, it takes longer for our bodies to metabolize alcohol and drugs,” said D. John Dyben, the director of older adult treatment services for the Hanley Center in West Palm Beach, Fla. “Someone might say, ”˜I could have two or three glasses of wine and I was fine, and now that I’m in my late 60s, it’s becoming a problem.’ That’s because the body can’t handle it.”

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Consider also the reasons given by Francis and Anne which are partly personal fears and partly about a false altruism. Not wanting to ”˜watch the slow decline of a partner’; fear of going to a nursing home; ”˜too many people on this earth’- making more pension money available for others; not wanting to ”˜dig into our savings’ and not being able to do the things they could at an earlier age. Add this to John Paul’s clear point that he didn’t want to look after them, and it’s almost a ”˜perfect storm’ of lack of imagination, lack of a willingness to care and to look towards other alternatives.

There is also an insidious cultural side to this affair evident in the reporting at Moustique. There is no alternate voice here; no suggestion that promoting this story might have a deleterious effect upon others. No help lines promoted, no questioning in any constructive way. The social question, as always, is about the cart and the horse ”“ is the media effectively pushing the issue or is it, as it may claim, simply reflecting the vox populi?

This is not a ”˜celebration of choice’; far from it. It is a rationalization devoid of humanity and created, in the first instance by the legal possibility of euthanasia. It is then abetted by whatever it is in that family and that society that confirmed and supported the kind of dysfunction that allowed the children to confirm and assist instead of saying a clear, No, and offering every alternate support, no matter what the cost.

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After I published a story about my grandmother’s dilemma on July 24 last year, I received hundreds of emails and letters from readers worldwide. Some wrote about struggles they’d experienced with their relatives. Others were anxious about their parent-care challenges ahead.

“I have never cried when reading a Bloomberg story,” wrote one reader. “I am going to make sure to talk with my grandmother about what she wants when she reaches that point.”

The story was also read by medical professionals. Kojiro Tokutake, a Japanese gastroenterologist, shared his story about his own internal conflict about the value of tube feeding. His experiences formed the basis of another story that I published.

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Britain may be the first country to appoint an “older workers’ champion.” Last month, pensions expert Ros Altmann was given the task to challenge outdated perceptions of the elderly and rewrite the rules on early retirement.

Her key message to employers and even workers themselves: A person’s talents and experience don’t stop at age 65.

Dr. Altmann’s appointment reflects two trends in wealthier nations. More people are retiring later. And many governments are reversing policies that encourage early retirement.

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The Rt. Rev. James Newcome, who speaks for the Church of England on health, has called for Lord Falconer to withdraw the Bill in favour of a Royal Commission on the subject.

The Bishop of Carlisle said: “It has brought the issues to the forefront of public discussion and highlighted what an important issue this is. Certainly, our hope as the Church of England is that the Falconer Bill will be withdrawn and that, because this is such an important issue, it could be discussed at length by a Royal Commission.”

A Royal Commission would allow the arguments to be “carefully assessed” and for expert opinion to be taken.

He added that the Church of England is in favour of the law on assisted suicide to remain unaltered as it provides a “good balance” between compassion and protection of the vulnerable.

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t’s not exactly “The Golden Girls,” but for Marcia Rosenfeld, it’ll do.

Rosenfeld is among thousands of aging Americans taking part in home-sharing programs around the country that allow seniors to stay in their homes and save money while getting some much-needed companionship.

“It’s a wonderful arrangement,” said the white-haired Rosenfeld, who when asked her age will only say she’s a senior citizen. “The way the rents are these days, I couldn’t stay here without it.”

She shares her two-bedroom, $1,000-a-month Brooklyn apartment with Carolyn Allen, a 69-year-old widow who has suffered two strokes and no longer wants to live alone.

Agencies that put such seniors together say the need appears to be growing as baby boomers age and struggle to deal with foreclosures, property taxes and rising rents. The typical situation involves an elderly woman, widowed or divorced, who has a house or an apartment with extra room and needs help with the upkeep.

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The arguments against assisted suicide are strongly held. Many people object on moral or religious grounds, while some doctors say that it conflicts with their oath to “do no harm”. Opponents add that vulnerable people may feel pressure to spare their carers the burden””or, worse, may be bullied into choosing suicide. And there is a broader argument that allowing assisted suicide in some cases will create a slippery slope, with ever more people being allowed (or forced) to take their own lives, even for trivial reasons.

But the arguments in favour are more compelling. In a pluralistic society, the views of one religion should not be imposed on everybody. Those with a genuine moral objection to assisted suicide need not participate. What a doctor sees as harm a patient may see as relief; and anyway it is no longer standard for medical students to take the Hippocratic oath. The hardest argument concerns vulnerable people: they may indeed feel pressure, but that is simply a reason to set up a robust system of counselling and psychiatric assessment, requiring the agreement of several doctors that a patient is in their right mind and proceeding voluntarily.

It is also true that as some countries relax their restrictions on assisted suicide, the practice will become more common and there will probably be pressure for other restrictions to be removed. But there is nothing unusual in this. Moral absolutes are rare. When faced with dilemmas societies draw boundaries and carve out exceptions.

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Up until yesterday for someone who has little love for what I consider to be a deeply flawed bill, it’s been pretty depressing following the coverage. The pro-assisted dying lobby are a slick and well oiled machine and it’s most vociferous cheerleaders have been out in force to bang the battered right-to-die drum. In contrast the voices of opposition, at least in the secular mainstream media, have been few and far between. Having spent some time attempting to record as many articles as possible from the papers and the BBC over he last week that have either had an opinion piece or an item on an individual or group with a partisan view, the results have been stark. There have been 34 pieces with strongly held views in favour of assisted dying and only 8 against. In the last day and a bit at least there has been a noticeable increase in the voices opposing the bill. This is partly because the BBC has produced various interviews, being very careful to finally balance their coverage and also because the Guardian somewhat surprisingly came out strongly against the bill and also published a powerful piece by the Bishop of Worcester whose wife died of cancer in April. Andrew Lloyd Webber has also revealed that he contacted Dignitas whilst struggling with depression last year seeking to end his life, but now believes that taking such action would have been “stupid and ridiculous”.

It’s not that those in favour have more to talk about, it’s more that the same things have been said more frequently. Predictably, so much of this talk has been emotive and far less has been focused on the mechanics of what assisted dying would look like in practice. ComRes have published a poll today that finds that although 73 per cent of the public back assisted dying in principle, this dwindles to 43% when they are presented with (mostly empirical) arguments against it. Doctors who need to be listened to and considered more than any other group still overwhelmingly oppose assisted dying, but you probably wouldn’t know it from the coverage in the last few weeks.

Having trawled the internet it has become apparent that much of what has been driving the media coverage has been the religious aspect.

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Many, including former Archbishop of Canterbury, Lord Carey, argue that it would have been the “compassionate” and “caring” thing to do. How difficult it would have been for Denise to argue with me if she was made to feel that she was a “burden” to myself and others. Had assisted dying been legal, I daresay the medics might have agreed with me, and the pressure on her, though subtle, would have been unbearable.

That is one of the many reasons I believe Lord Carey’s arguments to be so profoundly misguided and dangerous. He quotes a dying woman parishioner of his who whispered in his ear before she died that, “It is quality of life that counts, not length of days”. Well, maybe ”“ but who is to decide, when, and on what grounds?

Denise’s quality of life at the time of her prognosis and following it was poor by any standards. However, against the odds the chemo did have an effect and the tumour shrank for a while. Had assisted dying been legal, we might never have had the opportunity to enjoy the precious months together that we were given as the more debilitating effects of the treatment wore off. The despair of the moment would have determined our actions. What a tragedy that would have been.

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11.20 Lord Tebbit, whose wife was left disabled by the IRA’s bombing of the Brighton hotel, speaks against the Bill.

“No-one could dispute the good intentions of this bill, but the road to hell is paved with good intentions.

“I notice Baroness Greengrass talked of the right we have to take our own lives. We do not have that right. We have only the capacity to do it.”

It creates financial inventives to end the lives of the “ill, disabled, frail and elderly”.

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Care Minister Norman Lamb has said he has “changed his mind” and would now support a new law on assisted dying.

The Liberal Democrat told BBC Newsnight an individual should be able to “make their own decision about their life”.

But a cancer specialist told the programme it could create “death squads” by putting the decision in the hands of doctors.

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The $2.8 trillion Social Security Trust Fund is on track to be totally spent by 2030, the Congressional Budget Office said Tuesday.

That’s one year earlier than projected in 2013 and a decade earlier than the CBO estimated as recently as 2011.

The CBO delivered the warning in a gloomy long-term budget outlook that shows federal debt reaching 106% of GDP in 25 years, up from 74% now.

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I yield to no one in my respect for Lord Carey and for the good things he has said and done, but I am simply amazed at his arguments (or lack of them) in support of Lord Falconer’s Assisted Dying Bill for the terminally ill. Lord Carey says that he has changed his mind after encountering the cases of Tony Nicklinson and Paul Lamb, who had severe paralysis but were not terminally ill. In what way do these cases support a Bill specifically for those with a life expectancy of six months or less?

The majority of those who are terminally ill want what Dr Peter Saunders, of the Christian Medical Fellowship, calls “assisted living” rather than “assisted dying”. This is what the Christian-inspired hospice movement seeks to do, enabling those nearing the end of their lives to prepare for a peaceful and good death. The fact that good hospice care is based on a postcode lottery is what should shame us, rather than not having our own answer to Dignitas in Switzerland.

Instead of concocting expensive ways of getting rid of those at their most vulnerable, I strongly believe we should be making sure that good hospice care is evenly available across the length and breadth of the country.

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One in three cases of Alzheimer’s disease worldwide is preventable, according to research from the University of Cambridge.

The main risk factors for the disease are a lack of exercise, smoking, depression and poor education, it says.

Previous research from 2011 put the estimate at one in two cases, but this new study takes into account overlapping risk factors.

Alzheimer’s Research UK said age was still the biggest risk factor.

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As the social apparatuses and laws of post-Christian cultures continue to develop in ways opposed to Christianity, Christian churches faithful to the hope of the Christian message will have to create alternative structures of care for those who are dying. Rather than relying on for-profit hospices and state-funded apparatuses that participate in the utilitarian logic of assisted death, they will once again have to create hospices engaged in the Christian tradition of hospitality.

The narrative of Resurrection is opposed to the logic of assisted death. The hope of the Resurrection is not one of fanciful longing for reversal of physical death. Rather, the Christian narrative is one that claims that even the least of these can find hope, meaning and a life worth living in death’s darkest hour, and that death does not have the final word in the hard work of dying.

The work animated by the Christian message is what created health care in the West, and it is what should animate Christian care of the dying against the logic of assisted death in the regnant social structures of modern health care.

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“I am against Lord Falconer’s Bill because actually, it has got lots of holes in it and it is not really fit for purpose,” argued Dame Grey-Thompson, describing the Bill as “too vague”.

Speaking on internet station Fubar Radio, she added: “I am worried that there will be people, vulnerable people, who will think they have got no choice, who will be encouraged to choose assisted suicide when it is not really their choice.

“What we have to make laws for is to protect the vast majority of people in society and there are vulnerable people who just would not be protected and that is the biggest worry.”

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This takes me to the question of what does it mean to be alive. What constitutes quality of life and dignity when dying? These are big, important questions. I have come to realise that I do not want my life to be prolonged artificially. I think when you need machines to help you breathe, then you have to ask questions about the quality of life being experienced and about the way money is being spent. This may be hard for some people to consider.

But why is a life that is ending being prolonged? Why is money being spent in this way? It could be better spent on a mother giving birth to a baby, or an organ transplant needed by a young person. Money should be spent on those that are at the beginning or in full flow of their life. Of course, these are my personal opinions and not of my church.

What was done to Madiba (Nelson Mandela) was disgraceful. There was that occasion when Madiba was televised with political leaders, President Jacob Zuma and Cyril Ramaphosa. You could see Madiba was not fully there. He did not speak. He was not connecting. My friend was no longer himself. It was an affront to Madiba’s dignity.

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The Church of England (CofE) has called for an inquiry into assisted dying.

It follows a U-turn by former Archbishop of Canterbury Lord Carey, who said he would back legislation to allow the terminally ill in England and Wales get help to end their lives.

The current Archbishop of Canterbury Justin Welby says the Assisted Dying Bill is “mistaken and dangerous”.

But the Church said an inquiry would include expert opinion and carefully assess the arguments.

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Dorothy’s words ”” ”˜It is quality of life that counts, not number of days’ ”” ring in my ears.

The current law fails to address the fundamental question of why we should force terminally ill patients to go on in unbearable pain and with little quality of life.

It is the magnitude of their suffering that has been preying on my mind as the discussion over the right to die has intensified.

The fact is that I have changed my mind. The old philosophical certainties have collapsed in the face of the reality of needless suffering.

It was the case of Tony Nicklinson that exerted the deepest influence on me. Here was a dignified man making a simple appeal for mercy, begging that the law allow him to die in peace, supported by his family.

Read it all from the Daily Mail.

The compassion argument, as presented by proponents of the bill, runs something like this:

1 It is always right to act in a compassionate way;
2 Some terminally ill people face unbearable suffering and wish to have help in ending this suffering by bringing their lives to an end;
3 It is compassionate to provide
this help;
4 The law ought to be changed to allow this to happen.

Even if we leave to one side major difficulties in determining what legally constitutes “unbearable suffering” and “terminal illness”, the above argument is deeply flawed. Were it to be presented by a candidate in a GSCE religious education exam, I should expect an examiner to take a dim view of it.

The matter is, however, of more than academic interest; it is, in truth, a matter of life and death.

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I don’t need to remind you of the widespread concern about the ill-treatment of the aged and those at the end of life in some of our care homes and hospitals – and this in spite of the many dedicated people working in these fields of care. It seems all the more incomprehensible, then, that we would be considering a change in the law to diminish the protection given to those most vulnerable.

Next month a Bill to legalize “assisted suicide” for those at the end of life will begin its passage through Parliament. This legislation will be presented as a “compassionate” measure, whose sole aim is to relieve the suffering of the sick and the aged. Yet, it is far from compassionate to remove the legal protections provided for some of the most vulnerable members of society. The proposed change to our laws will license doctors to supply lethal drugs to assist the deaths of those expected to live for six months or less. If Parliament allows exceptions to the laws which protect the very sanctity of human life, it would be impossible to predict where this will end. In 1967, the politicians who legalised the killing of unborn children in limited and exceptional circumstances did not foresee how violating the sanctity of human life would lead to the wanton destruction of millions of lives. It is not surprising that many vulnerable people, including those with disabilities, are today worried by Lord Falconer’s “assisted dying” Bill. It might sound reasonable to speak of “choicesat the end of life” – as the campaigners for euthanasia do – but what choice will be left for many?

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Of course choice is good. I aspire to more of it and so do people who have enjoyed much less of it than I have. Offer me more choice, at least in theory, and I’ll say Yes. I’ll answer your loaded opinion poll and tell you I am in favour of this choice and that choice because who, in this culture, can be against more choice without being a heretic? But talk about choice on that day in the future when I am wholly dependent on the people around me, when my life is almost over and I have far more chance of pleasing others by getting out of their way quietly than of making much difference to my own situation, and my choice won’t be about me, it will be about them. And those last days of life, surely, are precisely the moment when choices ought to be about the one approaching the end – and no one else.

How many Parliamentarians who will shortly debate the Falconer Bill on assisted suicide are people with wide enough life experience to empathise with those who see more choice as a threat and not a blessing? How many subscribers to the BMJ put themselves, day by day, into the shoes of people for whom consumer choice is someone else’s luxury, even if their editor chooses to use his journalistic position to make a ruling on behalf of ethicists everywhere?
Some of them, to be sure – maybe many of them. Will they encourage the rest to dig deep into their imaginations, to empathise with people who are not articulate, who are used to being done unto, and who have lived on the receiving end of other’s choices all their lives?

They are in Parliament to govern on behalf of all citizens. The weak. The poor. The vulnerable. The dying. The ones who don’t want to be a nuisance. The ones who do not regard choice as an unalloyed good, as well as the people who are used to choosing. And the medical profession too – despite the sweeping assertions of the BMJ about the nature of ethics, are also in business for those people.

Will the Parliamentarians and the medics empathise beyond their own kind? I hope so. I do hope so.

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If you are considered a burden by others, you sense it. Like Dr Ashton’s youngish men disheartened not to be the breadwinners, sick old people may well be overwhelmed by a sense of rejection, made worse by physical pain. The supporters of Lord Falconer’s Bill make much of the fact that those handed out the “only six months to live” sentence proposed by the Bill will take the fatal drugs it provides themselves, and by their own choice. But what in the culture will guide that choice? What is the effect on the patient’s free will when a profession whose entire previous raison d’être has been to assist life now stands ready to give you the tools of death?

Once it becomes legal that such a thing could happen, how long before it becomes expected? Most old people in hospital try to conform to what they think the system wants. If it wants them dead, and gives them the power to die, their grim path of duty lies clear. Some will have families who do not care enough whether they live; others will have no families at all. To all of these, Lord Falconer’s “choice” could become as proverbial as Hobson’s.

It does not have to be this way. Think of the revolution in attitudes to the disabled and mentally handicapped that has taken place in the past 40 years.

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One French court acquitted a doctor of poisoning seven terminally ill patients while another ordered physicians to suspend treatment for a comatose man, while Britain’s top court said the country’s ban on assisted suicide may be incompatible with human rights.

The decisions of the past week are fueling the arguments of Europeans who say the duty of doctors is to end the suffering of those beyond treatment.

But emotions run high on all sides around the issue of euthanasia and assisted suicide, as is shown by the bitter case of the comatose Frenchman, Vincent Lambert. Hours after the French court sided with his wife in ordering an end to treatment, the European Court of Human Rights blocked the move at the request of his parents, in a rare late-night ruling.

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French law now contains guidelines for palliative care, discontinuing life support and other matters. Yet the debate surrounding Mr Lambert’s case differs little from the debate over Humbert.

In urging patience, the European Court acted responsibly. Few of the desperately ill are truly incommunicado or lack any kind of “living will” or directive. And drawing up rules for securing the “dignity” of patients is a dangerous business in the best of cases. Death by natural causes, as we have always understood it, involves many things we consider undignified.

Assertions that the patient “wouldn’t have wanted to suffer” can offer too much leeway to doctors and relatives. The danger is that we will turn the “end of life” into an excuse for making exceptions to our medical and moral common sense.

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As lawmakers continue the call for answers into the troubled Veterans Affairs health care system, including South Carolina’s Sen. Tim Scott, the White House released findings Friday describing “significant and chronic system failures,” substantially verifying problems raised by whistleblowers and internal and congressional investigators.

A summary of the review, ordered by President Barack Obama and conducted by deputy White House chief of staff Rob Nabors, says the Veterans Health Administration must be restructured and that a “corrosive culture” has hurt morale and affected the timeliness of health care. The review also found that a 14-day standard for scheduling veterans’ medical appointments is unrealistic and has been susceptible to manipulation.

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For Jerry Conkle, life in America’s fastest-growing metropolitan area moves as slowly as the golf carts that meander through his palm-lined neighborhood at dusk. Most days, he wakes early, reads the newspaper, and then hops into his four-wheeled buggy for a 20-mile-per-hour ride to one of the 42 golf courses that surround his home.

“It’s like an adult Disney World,” Conkle, 77, said of The Villages, Florida, whose expansion has come with virtually no crime, traffic, pollution — or children.

The mix has attracted flocks of senior citizens, making The Villages the world’s largest retirement community. Its population of 110,000 has more than quadrupled since 2000, U.S. Census Bureau data show. It rose 5.2 percent last year, on par with megacities like Lagos, Nigeria, and Dhaka, Bangladesh.

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Revd Dr Brendan McCarthy, National Adviser: Medical Ethics and Health and Social Care Policy for the Archbishops’ Council, said….”We remain convinced that the current law and the DPP guidelines for its application provide a compassionate framework within which difficult cases can be assessed while continuing to ensure that many vulnerable individuals are given much needed protection from coercion or abuse….”

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The American people — most of us, anyway — did “choose” to provide first-class medical care for our veterans. But we didn’t do it. We set up the Veterans Administration to do it. And the Veterans Administration — or, more accurately, some of the people who work for and run the Veterans Administration — had a stronger interest in other things. Things like fat bonuses, and low workloads in comfy offices.

Thus we find that, even though veterans were dying, and books were being cooked, every single VA senior executive received an evaluation of “fully successful” or better over a 4-year period. That’s right. Every single one. Over four years. At least 65% of them received bonuses (“performance awards”). All while veterans around the country were suffering and dying because of delayed care. The executives got these bonuses, in part, because they cooked the books, because the bonuses were more important to them than the veterans’ care.

It would be nice to believe that this sort of problem is limited to the VA, but there’s no particular reason to think that it is. The problem with the VA is that, like every other government agency — and every other human institution — it’s not a machine that runs itself. It’s a collection of people. And people tend to act in their own self interest.

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