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Choices - Death and Dying
Ernest H. Rosenbaum, MD

Dealing With Death and Dying- A Good Death

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You have no choice in how and when you were born, but you do have a choice, in part, in how you die. It is probably the most important choice you will ever make! Thus, planning for your end of life care can includes your death requiring wills and medical directives which are important to help ensure that your needs will be met as you wish.

The important thing to do is to write down your wishes and directives, and complete your wills to help not only assure you that your wishes will be met, but also will relieve uncertainties and conflicts for your survivors after you die

Dying is a medical event at the end of one's life, but it can offer an extraordinary opportunity for family and friends and patient to interact and grow.

Death has always had a sacred place in life, and although we all would like to choose how and when we die. There is a movement toward more institutionalized hospital or hospice care. Although, it may be more propitious to promote home care, such as was more common 50 to 100 years ago. Of course many of the options depend on the clinical medical condition and need for end of life care to assure as painless as possible a death with minimal suffering

Communities have been organized and inspired through recent leadership for the hospice involvement in the dying process, whether it be inpatient or home hospice. There is also increased interest in the religious and spiritual dimensions during the dying process, and, in part, this is a journey of the spiritual and soul in the transformation process.

Thus, improvements in the care of the dying have changed with the emphasis on dignity, compassion and empathy.

We are judged not on what we say but what we do. Our accomplishments and failures are a summation of our life.

Each life has a scale with a delicate balance. The weights of our successes, failures and trials, have a significant effects on ourselves, family and friends.

For each of us, the balance of the scale is what we have done in our life for for humanity in general. In failure, we may strive to retry to succeed, and in success, there will be great satisfaction in achieving a healthier and more satisfactory life.

If success is not achieved, may we accept our fate without anger or remorse or bitterness, so that whatever time we have yet to live may still have positive aspects.

Since death is a part of life - let us try to accept it at its appointed time but till then La Chiam - to life. We have choices in how we live each chapter of our life, and although there will be many compromises, detours and changes that can either be accepted or rejected, we still may, in part, determine our destiny and fate.

Thus, in conclusion, each of us has the capacity to live each day a little better, but we need to focus on purposes and goals and then set into action a realistic plan that will help us achieve these goals.

We can light a candle for ourselves and observe the glow as it slowly burns down while we reflect our failures and successes of the many events in our life - the achievements or gains as well as the reverses. Only by using the power of the will to live, which is nourished by hope, can one achieve the sublime feeling of knowing and experiencing the wonders of life and appreciating its meaning through vital active living.

These are some of the resources that are the foundation of the will to live. Thus, one should try to never give up, but one should take advantage of the opportunities available.

Dealing With Death and Dying- A Good Death
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Death is a one-way street, which everyone will travel at some time. The real question is how we die - where, when, and how? For the patient - as we age, we acquire age-related diseases and comorbidities that, in many instances, complicate life.

Patients would like the following:
1. A pain-free, controllable future.
2. Good medical care.
3. Good supportive care.

A good death can often come after a good life. Death, thus, becomes not only a moment in time but at the end of life it has a relationship with all around. Hopefully, we will die peacefully and simply with friends and family around to help us live better through this last chapter in life. People often live after making preparations for dying, which can often give a great deal of mental relief and support, as they try to live as long and comfortably as possible.

There are a lot of regrets and sorrows during the dying period, which are often relieved, in part, through supportive conversations with the medical team, family, and friends. Anger and forgiveness need to be addressed, and this requires good communication, especially to defuse anger. Knowledge is also important, and this often helps in controlling physical and mental symptoms.

There is also a time to let go, and if one's luck or good fortune in therapy no longer remains effective, your faith can have great importance for either a good or bad death. Faith and courage and religion or spirituality are also very important.

There are also the unforeseen decisions on how to die - in fear or heroically. You often live for a cause, and, as often seen in war, heroic death for a belief or a cause can have great meaning.

In dealing with death, one has to also consider what's important to life, as well as the meaning of life.

Much effort has been devoted in recent years to the end of the dying process and less on the living. The hospice movement and the reviews by Elizabeth Kubler-Ross on death and dying has made a great impact on society.

Spirituality also has a part of this growth process. Death can be considered as not leaving but a transformation.

An approach might be that before and after death, the family sits around the bedside and just tells stories and remembrances, especially of the good events in life

It is believed that the last sense to go in life is that of hearing, so talking to a dying patient about love and support is a good practice.

It is a good idea to do an ethical will which can record events and your philosophies of one's life.

Different cultures make an impact due to beliefs, such as those of Blacks, Latinos, Haitians, Cubans, Christians, Muslems and Jews, as all these have different thoughts on life and death, as well as life-saving procedures, such as receiving CPR - cardiac resussitation or being on a breathing ventilator.

Most cultures believe in the afterlife, and it has been estimated that up to 74% of people hope that there is a heaven and that the afterlife will be better than what they've gone through in their current life.

Of note is that even many thousand years ago, the Neanderthals thaught that a spirit would survive death, and this subsequently led to many other religious beliefs, not only in life, but also for death.

Buddishts, for example, ring the bells at the time of the bone festival to notify ancestors. There appears to the spirits of dead ancestors, who are welcome back for a week to spiritually and emotionally interrelate. This is a Japanese belief.

The power of the spirit depends on what you want to believe. It's a matter of cultural belief, but proof is hard to find. Thus, a person's religious and philosophical cultural beliefs affect the dying process.

There is a need for humanizing death as a part of a transition, for, as stated, 74% of Americans believe in the afterlife.

Some religions offer eternal life, and a lot depends on your faith and how you deal with and control your thoughts and emotions.

To fear death is normal. But to let it be your obsession negates your chance of living well.

The ultimate control of life and death is that of hope and the love and support of family, friends and the medical team.

Death, in its proper place, must be looked upon as a friend and not as an enemy.
Eugene A. Stead, Jr.,
Professor of Medicine, Duke University Medical School.

Death is a part of life.
Life without living is unreal!
To just prolong life with heroics is not our goal.
But until death occurs, one has to live each day with new and hopefully good experiences.


To find one's happiness
The path is kindled by supportive help
The worth of a loving smile
The most important is love for another
And this makes life complete and meaningful.


Never judge your friendship on money
Because the dollar is round, and it rolls from person to person.

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