Diane's Blog
| July 18, 2008 | October 5, 2008 | |||
| July 19, 2008 | October 17, 2008 | |||
| July 20, 2008 | November 1, 2008 | |||
| August 29, 2008 |
This blog is for Transition Guide Trainer students, as well as those interested in learning how to be a Transition Guides for their loved ones or friends. I will be writing about the training programs, the people who have become certified and are developing thier own classes, what's going on in the fields of end of life support, conscious dying and aid-in-dying, and respond to emails from you concerning these issues. I'll respond to your questions, comments, opinions and rants in the blog.
I decided to start this blog while reading the Spring 2008 "Compassion and Choices Magazine" today and coming across several items I thought worthy of passing on to those interested in the development of this emerging field. Before I get to them, a few words about Compassion and Choices. It is the result of two non-profits merging to provide more services. Compassion in Dying organized to challenge the legal system to make "assisted suicide" legal at the state level. Oregon became the first state to do so and certain rules and restrictions are in place to prevent wholesale slaughter of the elderly and disabled. The Hemlock Society, which was based on Derek Humphry's book, "Final Exit," provided the means for self-administered-suicide. A few years back, The Hemlock Society dissolved and merged with Compassion in Dying to become Compassion and Choices. I had been a supporter of Compassion in Dying for many years. I attended one local meeting of The Hemlock Society years ago but it was too argumentative an environment for me at the time. Jack Kervorkian was in the news for opening the door to freedom of choice. Attitudes and values about end of life care have evolved to a more humane approach favoring freedom of choice. The new organization is a further step toward allowing the option to choose a planned, peaceful death. Compassion and Choices is currently lobbying to get an initiative on the ballot in November in Washington state to make it legal to self-administer life-ending medication to achieve a peaceful death... death with dignity, death on one's own terms. There is a massive educational effort going on in California and several other states at this time. Compassion and Choices is grant-funded and supports, educates and advocates for choice and care at the end of life. They changed the term "assisted suicide" to "aid-in-dying" to make the intent of compassion more clear. They educate physicians and pharmacologists about prescribing the best medication, which gives patients the option to fill it, to have it near their bedside, to self-administer-- or not. It gives patients and families the option to discontinue further medical treatments and move on to palliative care. They also train volunteers to increase awareness in their communities about choice and care at the end of life, and advocate for patients' rights in end of life issues. I predict that one day Compassion and Choices will merge with Hospice to provide even more comprehensive, holistic support and education to those facing difficult choices. It could be called Compassion and Choices and Care. I'm hoping to train someone in Compassion and Choices to be a Transition Guide Trainer so they can train their volunteers to be Transition Guides, just as I'm hoping to train some hospice trainers so they can train their volunteers to be Transition Guides. It all appears to fit together nicely.
Go to their web site at compassionandchoices.org if you want to get involved. What follows are excerpts from the Spring 2008 magazine--
The Washington Initiative I-1000 would
- Allow terminally ill patients the choice to end life on their own terms. Currently, Washington residents facing a prolonged and painful death have limited legal end-of-life options.
- Mirror Oregon's Death with Dignity Act. The text of the Washington ballot measure is based on the successful 10-year old Oregon law.
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Language Matters
On Feb. 29, 2008, a Washington Court rejected the use of biased language in the I-1000 Initiative text.
Aid-in-dying opponents had campaigned to require the term "suicide" in the ballot language and voters pamphlet, a continuation of a broader campaign to promotoe inaccurate language when referring to aid in dying.
Thurston Country Superior Court Judge Chris Wickham refused to include such language, ruling the term "suicide" is "loaded."
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Ethical and Religious Directives for Health Care
Catholic hospital employees must follow the church's Ethical and Religions Directives for Catholic Health Care Service (ERDs), which provide explicit theology-driven policy guidelines for care. The ERDs can replace patient choice with the bishop's own discretion. The church, not the patient or his loved one, ultimately directs a patients treatment.
The institution will not honor an advance directive unless it conforms to Catholic teaching. The Bishop-- not the individual-- determines whether the benefit of treatment outweighs the patient's burden. The ERDs clearly state a Catholic health care facility "will not honor an advance directive that is contrary to Catholic teachings."
Even conscious patients and those with advance directives may not be permitted to end life support or pursue aggressive pain care. According to the directives, "The free and informed health care decision of the person or the person's surrogate is to be followed so long as it does not contradict Catholic principles."
The ERDs advise a "presumption in favor of providing nutrition and hydration to all patients." Patients who wish to refuse intravenous or tube feedins are at the mercy of the bishop's discretion.
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www.youtube.com/CompassionChoices to watch videos
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Nancy Crumpacker, MD - Compassion & Choices of Oregon Medical Director - Named "Volunteer of the Decade"
Q: How do you explain your work when you meet someone new?
A: Simplistically. Coordinating with patients and getting their desires met with their physicians, along with the hospice care team. I talk to patient's to see if it's the right fit, then I work with them to talk to their physicians.
My primary service is to patients and physicians. We assist with up-to-date information to safeguard the law.
On occasion, I speak to physicians and pharmacists who are opposed. My rule in these conversations is to avoid antagonizing them because we have witnessed persons in both professions change their minds.
I always urge patients to talk to their personal physicians so doctors become familiar with the legal procedure. In other words, a physician needs to be aware that his or her patient might give this option serious consideration. Physicians' responses to this infrequent intimate request vary based on circumstances and experiences that change over time.
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Monique Bondeux, Co-founder, Compassion & Choices of Utah
Q: What do you say when you encounter opposition?
A: First, I specify that "suicide" is an inaccurate qualifier for the process of a hastened death. My first line response is to quote Assemblywoman Patty Berg, who said when speaking of the California Compassionate Choices Act, "Suicide suggests you have a choice between living and dying. For those terminally ill and mentally sound patients who seek to hasten their death, the choice of living is past. Their only choice is between dying horribly or dying mercifully." It works quite well to curtail further expressions of righteous outrage.
Another effective response is, "Have you ever tended to a parent, or know someone dying of ALS or some other dreadfully incapacitating disease? Have you witnessed their and their families' intense frustration, despair and pain? Wouldn't you have preferred seeing them out of their misery? Especially if that's what they wanted in the first place?
My personal bottom line is the quality versus the quantity of life. Most of all, it's about freedom of choice.
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I kinda figured that about Catholic hospitals, but what got my attention in another article was how many hospitals the Catholic Church is buying up. I'm going to be sure to find out who owns any hospital I might have to check in to. Another important point is to ask whether a Compassion and Choices advocate is available at the hospital for consultation so you'll know what options are available depending on the diagnosis. And, finally, I agree with Ms. Bondeux, freedom of choice is the important thing.
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Came across another reason today to be certifying more Transition Guide Trainers in the July-August 2008 AARP Bulletin. The article is "Cash for Care" by Sid Kirchheimer. He writes about a man with a malignant tumor who was referred to a local cancer center, where he was told that he was looking at $30,000 worth of treatment and they wanted $20,000 up front. He had just recently paid off $273,000 in out-of-pocket costs for his ex-wife's care for ovarian cancer, his insurance wouldn't cover her, and she died anyway. He was rejected for "charity care" because he still had $10,000 in a 401(k). He's still weighing his options, possibly seeking surgery in another country, but it sounds like people are being sent home to fend for themselves because they can't afford medical treatments. The problem is with hospitals too. They are required by law to treat medical emergencies without payment, but for people with long-term care needs, such as cancer or heart disease, which may be life-threatening but are not medical emergencies, they may ask for up front payments. As this gets worse, more people may opt for hospice and become interested in learning the art of conscious dying.
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This is an article a friend sent me from a hospital newsletter, which shows that even hospitals are strating to offer end of life education to employees. In thinking about what you can do as a Certified Transition Guide Trainer, consider offering community education programs. Nurses who become Trainers can offer CEU classes to hospitals, health care providers and caregivers.
AN "END OF LIFE EDUCATION SERIES" WILL BE HELD FROM 5:30 TO 6:30 PM THE THIRD THURSDAY OF EACH MONTH AT MANATEE MEMORIAL HOSPITAL. TOPICS INCLUDE: CULTURAL CONSIDERATIONS IN END-OF-LIFE CARE, ETHICAL ISSUES IN PALLITATIVE CARE NURSING, ACHIEVING QUALITY CARE AT THE END OF LIFE, PREPARATION FOR AND CARE AT THE TIME OF DEATH. ONE CONTACT HOUR IS PROVIDED TO MED TECHS, CNA'S LPNS, RNS AND ARNPS (MUST BRING PROFESSIONAL LICENSE NUMBER, ETC...CALL ...
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Palliative care is a growing field that students, particularly nurses, may someday find employment in as a Transition Guide training program is a good fit. This quote is from The Center to Advance Pailliative Care web site--
While only a handful of palliative care programs were in existence five years ago, today over 1,100 hospitals in the U.S. provide palliative care services to their patients. In 2003, the American Hospital Association reported a 22% increase in the number of hospital-based palliative care programs over the previous year. Support for hospital-based palliative care also extends to the hospice community. A national survey showed 87% of hospices thought hospices should develop hospital-based palliative care services for patients who do not qualify for or elect hospice services.
If you want to get involved-- CAPC is the leading source of practical expertise and assistance for advocates working to ensure the success of interdisciplinary palliative care teams in their institutions.
Another good source for information is the National Hospice and Palliative Care Organization. This is a good Handout.
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•I can't believe a month has gone by since I last blogged. I hope to update at least monthly but will add news worthy items as they come up. I hope to use this page to let people who feel attracted to this work know that progress is being made and also that I'm just one person, not an organization at this point. I hope it will soon become an organization (non-profit) to maintain a network for Transition Guide Trainers to keep up with what's going on in the field, but more needs to be done before that happens. My job is to contribute energy to the momentum of this expansion of consciousness, which I have been doing for almost 20 years, and I'm seeing that it is gathering speed. What I need now are people who are interested in being part of this to contribute their time, energy, talents, abilities, creativity or resources to take it to the next level. This isn't about me, this is a spiritual/social movement evolving toward compassionate care in dying. I've been talking to/emailing a number of people I've come across online who are doing their own thing along the same lines as I am and organizations that are showing interest in what we all are doing. It all seems to be coming together at this time in our history so if you feel you are part of this movement and can see yourself doing this work in years to come, let me know of your interest and expertise.
I've been teaching the online Transiton Guide Educator's training program for the past 4 weeks and realizing how time consuming that is for me, thus I've decided 8 students at a time is too many. If you look at the next course update you'll see that I've limited it to 4. I'll keep a waiting list in case someone has to drop out and for the first class next year.
•I'm also in the process of deciding how best to present the course. I think it's beneficial for students to practice the exercises (e.g., meditation, guided imagery) during the week between weekly class meetings, which is why I wrote it as a 6-week course. The manual breaks down into 6 topics as well. However, I'm thinking now that it's too long/too expensive and too time consuming for me. What I'm considering is recording the course onto CD so people can study at their leisure then possibly offering a weekend online conference for certification. It would be more efficient and I could certify more trainers quicker to get them out in the field doing the work. It would bring the cost of the training down because it wouldn't involve so much of my time. I'd appreciate any feedback from people interested in taking the training about what you think about taking the course on CD and a weekend online certification program versus the 6-week online program (see Syllabus). I'm looking into the cost of producing the CD, packaging, etc., which I could probably mostly put together myself but it would be an amateurish production and I really don't have time, so if anyone can offer help if I decide to go that route that would be great. This would also involve getting the funding to produce the finished product. Someone with grant writing experience including how to find appropriate funding sources could be very helpful.
•The other major chunk of my time is spent marketing, trying to get the word out to the public that there is a better way to die, and trying to find people who want to become certified trainers and be pioneers in the movement toward treating dying as a natural, beautiful part of life... not an end but a new beginning and an opportunity for greater spiritual development. Not easy to get across in today's world, but it is starting to emerge among the mainstream in conversations about near death experiences, conscious dying, aid in dying, the afterlife. I've written articles and attached them to social networking sites like ByRegion. net (healers and artists) and SelfGrowth.com (self-improvement), and others, and will continue to do so, but I'm also looking for writers who would like to write their own articles to submit to various magazines and ezines. I'm available for interviews (email me with ideas for your article and we'll schedule an interview). I've been doing internet radio interview shows, but I'm looking for people who want to become trainers and do some of the public relations beyond their local area. I don't want to go on TV or tour the country doing workshops or TV interviews, that's not where I'm most effective. I suggest students do this at their local level (radio, TV, newspapers), through their businesses (classes, workshops, seminars), within their organization (in service, conferences), in their communities (Jr. college classes, senior citizen groups, caregiver classes). There is also the national level and any educational activities you care to get involved in would help spread the word to the general public that this service is available to all, not just the dying, not just hospice patients. You could write articles for national magazines, you could write your own book and do the national talk show circuit, be on Oprah! You can hold workshops at national conventions and conferences, speak to medical professionals and healthcare workers, you could write a screenplay or do a documentary. Use your imaginations to find your unique way of getting this information out to the world.
•I've been in contact with an organization that wants to standardize hospice volunteer training with online (core) courses and they're interested in what I'm doing as a specialty option. We haven't gotten into details yet but I'm thinking I may have to write another online training course specifically for hospice volunteers who want to specialize in teaching the art of conscious dying. Certified Transition Guide Trainers could be mentors for volunteers taking the course. I'll be looking for help from Trainers with writing the curriculum and will update progress with this group in this blog.
•I've been in contact with a person doing something similar to my program but from a Buddhist perspective who talked about organizing an annual conference on death & dying. I'd like to have several Trainers at that conference doing workshops, having a booth, talking to people about becoming Transition Guides for their family members, passing out brochures, and offering classes. It may take a couple of years to get such a project off the ground which would give you time to become certified and develop your Transition Guide training program. There may also be opportunities to help organize, raise money, prepare materials, work the floor, etc. for people other than Trainers who are interested in this field.
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I had to take some time off to reorganize my priorities so for the past 3 weeks I've been up in Oregon visiting my younger daughter and 3 grandchildren. They are 10, 7 and 2. My daughter went back to teaching (4th grade) this year so I've been getting in lots of babysitting time. I've had one hospice transitions patient who is wheelchair bound, recovering from a broken hip. She is 92 years old, a former nurse in the middle stages of Alzeheimer's, able to understand and remember bits and pieces. I've been reading to her from Maria Dancing Heart's Last Adventure in Life. After a story, she starts to discuss what I read then lapses into nonsense as if it were meaningful. The first time I visited she asked me what was coming next for her and I told her God would reach out his hand and all she had to do was take it. She said she hoped I was right. When we got her into bed for a nap, she began repeating the rosary... pray for us sinners now and at the hour of our death... God have mercy, God have mercy, God have mercy... Holy Mackeral! Sounded like she was sensing the light on the other side. Sad that I have to turn her over to another volunteer who isn't a Transition Guide.
I'll be driving home this weekend, making it a one day drive instead of two because it's too cold to camp out overnight. We had snow down to the 4000 foot level yesterday, beautiful on the mountains. Might be some good photo ops along the way with snow and golden aspens.
Next radio interview for Diane will be with Pamela Edmunds, Medium, Holistic Practitioner and host of "Bridge Between Two Worlds" on October 13th at 7 pm EST. Pamela is moving to a new station broadcasting from Boston reaching Southern New Hampshire to Cape Cod to Worcester, Massachusettes. Check the revised Schedule at http://www.bridgebetweentwoworlds.net after October 6th. After the live broadcast, the show will be available in the Archives. We're going to talk about how Transition Guides assist friends and loved ones as they are getting ready to leave for the spirit world. It would be great if some of you would call in with your questions.
I certified a new student last month in Austin, Texas. Her name is Donna Belk. She's a yoga teacher who is also a celebrant for home funerals and has added Transition Guide classes to her services. Feel free to email her and ask questions about the Educator Training and the program she is developing. Her new web site is consciouslivingdying.com.
I hope to start working on recording the training manual and creating the CD version of the course and the weekend certification program the rest of this year... and that it will be ready early next year. Will keep you posted on the developments.
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Listen to Diane's interview with Pamela Edmunds on Bridge Between Two Worlds (10/13) about Transition Guide Training (not yet available online, site being redesigned)
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See some amazing new videos I've come across which are now listed on Recommended Links:Videos. Send me your favorites.
Forgiveness and the Freedom of Letting Go
The Gentle and Forgotten Art of Blessing
Life After Life: What happens when we die? - Now you can view all twelve chapters of the Life After Life film, free online. Life After Life reveals amazing clues to life’s greatest mysteries. This NEW YORK FILM FESTIVAL Award Winning film tells the worldwide story of Life beyond Death.
UK debates assisted suicide - CNN.com video
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I've started the recording process, and am gathering photos and data for the power point presentation of the training program. I'm hoping it will be available January 2009. The training package will include the training manual and a DVD, which will become a self-study course that may be purchased separately. Those who wish to become Certified Transition Guide Trainers with license to teach this method to others can take a weekend teleconference class after completion of the self-study course and turning in assignments. I may offer that once or twice a month. I'm still workiing on the details and will keep you posted. As always, I welcome your comments and suggestions.