Julia Medew in The Age:

The two scientists relished life. They skied, went bushwalking and climbed mountains, often taking their three young daughters with them. Their cultural and intellectual pursuits were many - classical music, opera, literature, wine, arguments over dinner with their many friends. They donated 10 per cent of their annual income to political and environmental movements. Family events were spent thoroughly debating the topics of the day.

As their capacity declined, the conversation about ending their own lives became more serious and their rejection of what Peter called “religious do-gooders” became more fierce.

“It was also a way into their favourite topics; philosophy, ethics, politics, the law …,” says their youngest daughter, Kate. “The idea that their end-of-life decisions could be interfered with by people with the superstitions of medieval inquisitors astounded them, and alarmed them.”

Via Next Draft

Robin Marantz Henig in The New York Times:

When Sandy Bem found out she had Alzheimer’s, she resolved that before the disease stole her mind, she would kill herself. The question was, when?

Catrin Einhorn in The New York Times:

Cullowhee, N.C. — The body of the tiny 78-year-old woman, gray hair falling over stiffened shoulders, was brought to a hillside at Western Carolina University still clad in a blue hospital gown and chartreuse socks.

She was laid on a bed of wood chips, and then more were heaped atop her. If all goes as hoped, the body will turn into compost.

Jan Hoffman in The New York Times:

Until recently, most clinical teams believed that adolescents would not understand the implications of end-of-life planning and that they might be psychologically harmed by such talk.

Sometimes when providers do make the attempt, parents or patients may abruptly change the subject, fearful that by joining in, they are signaling that they have abandoned hope.

Yet research shows that avoiding these talks exacerbates the teenage patient’s fear and sense of isolation. In a 2012 survey examining end-of-life attitudes among adolescent patients with H.I.V., 56 percent said that not being able to discuss their preferences was “a fate worse than death.”

Jon Mooallem in The California Sunday Magazine:

There’s an ugliness — an inelegance — to death that Paul Bennett gradually came to find unacceptable. It seems to offend him the way a clumsy, counterintuitive kitchen tool might, or a frumpy font. At first, that disgruntlement was just “a whisper in my mind,” Bennett explains. “But it’s gone from being a whisper to a roar.” The solution, when it finally occurred to him, felt obvious. “Oh,” he told himself. “You need to redesign death.”

Elizabeth Lopatto in The Verge

She’s clawed out two years; I’d like longer, but that’s not in the cards.

And this is where I feel I have been better served by my vet than many patients are by their doctors: we have had, for the last two years, a continuous conversation about Dottie’s end-of-life plan. No one has ever promised me a cure, or made me hope Dottie will beat cancer.

Pam Belluck in the NYT:

“We think it’s really important to incentivize this kind of care,” said Dr. Barbara Levy, chairwoman of the A.M.A. committee that submits reimbursement recommendations to Medicare. “The idea is to make sure patients and their families understand the consequences, the pros and cons and options so they can make the best decision for them.”

Now, some doctors conduct such conversations for free or shoehorn them into other medical visits. Dr. Joseph Hinterberger, a family physician here in Dundee, wants to avoid situations in which he has had to decide for incapacitated patients who had no family or stated preferences.

Recently, he spent an unreimbursed hour with Mary Pat Pennell, a retired community college dean, walking through advance directive forms. Ms. Pennell, 80, who sold her blueberry farm and lives with a roommate and four cats, quickly said she would not want to be resuscitated if her heart or lungs stopped. But she took longer to weigh options if she was breathing but otherwise unresponsive.

“I’d like to be as comfortable as I can possibly be,” she said at first. “I don’t want to choke, and I don’t want to throw up.”

With reimbursement, “I’d do one of these a day,” said Dr. Hinterberger

There are two things I care passionately about, and believe american culture (western culture generally) have wrong; education, and death. Here is a great piece on the latter. This is not something we can fix through legislation. (see: Death councils). It will have to be a cultural shift.

Atul Gawande in The New Yorker:

A few days before Thanksgiving, she had another CT scan, which showed that the pemetrexed—her third drug regimen—wasn’t working, either. The lung cancer had spread: from the left chest to the right; to the liver; to the lining of her abdomen; and to her spine. Time was running out.

This is the moment in Sara’s story that poses a fundamental question for everyone living in the era of modern medicine: What do we want Sara and her doctors to do now? Or, to put it another way, if you were the one who had metastatic cancer—or, for that matter, a similarly advanced case of emphysema or congestive heart failure—what would you want your doctors to do?

The issue has become pressing, in recent years, for reasons of expense. The soaring cost of health care is the greatest threat to the country’s long-term solvency, and the terminally ill account for a lot of it. Twenty-five per cent of all Medicare spending is for the five per cent of patients who are in their final year of life, and most of that money goes for care in their last couple of months which is of little apparent benefit.

And the hour long documentry on Frontline is here. Trailer for that:

Roger Angell in The New Yorker:

I’ve endured a few knocks but missed worse. I know how lucky I am, and secretly tap wood, greet the day, and grab a sneaky pleasure from my survival at long odds. The pains and insults are bearable. My conversation may be full of holes and pauses, but I’ve learned to dispatch a private Apache scout ahead into the next sentence, the one coming up, to see if there are any vacant names or verbs in the landscape up there. If he sends back a warning, I’ll pause meaningfully, duh, until something else comes to mind.

On the other hand, I’ve not yet forgotten Keats or Dick Cheney or what’s waiting for me at the dry cleaner’s today. As of right now, I’m not Christopher Hitchens or Tony Judt or Nora Ephron; I’m not dead and not yet mindless in a reliable upstate facility. Decline and disaster impend, but my thoughts don’t linger there. It shouldn’t surprise me if at this time next week I’m surrounded by family, gathered on short notice—they’re sad and shocked but also a little pissed off to be here—to help decide, after what’s happened, what’s to be done with me now. It must be this hovering knowledge, that two-ton safe swaying on a frayed rope just over my head, that makes everyone so glad to see me again. “How great you’re looking! Wow, tell me your secret!” they kindly cry when they happen upon me crossing the street or exiting a dinghy or departing an X-ray room, while the little balloon over their heads reads, “Holy shit—he’s still vertical!”

Watched “How to Die in Oregon” last night. Terribly flawed documentary, which I don’t recommend, but pretty brutal, and very convincing. We put cats and dogs down to avoid their unneeded suffering. Why not our parents?

Scott Adams on his blog:

My father, age 86, is on the final approach to the long dirt nap (to use his own phrase). His mind is 98% gone, and all he has left is hours or possibly months of hideous unpleasantness in a hospital bed. I’ll spare you the details, but it’s as close to a living Hell as you can get.

If my dad were a cat, we would have put him to sleep long ago. And not once would we have looked back and thought too soon.

See also this great news story: French couple, 86, slam ‘cruel’ law in suicide note

The couple, together since their teens, checked into the world-famous Hotel Lutetia on Thursday night and at some point in the night, they took medication designed to induce a painless death, according to Le Parisien. The couple also ordered breakfast to be delivered to their room in the morning to ensure they would be found quickly.

Georgette and Bernard were discovered dead, hand-in-hand, in their bed on Friday morning by a member of staff. Two letters were left by their bedside.

On Monday it was revealed that one of them contained a scathing attack on France’s prohibition of euthanasia.

Via Warrenellis.com.

A Dutch TV station says it will go ahead with a programme in which a terminally ill woman selects one of three patients to receive her kidneys. Political parties have called for The Big Donor Show to be scrapped, but broadcaster BNN says it will highlight the country’s shortage of organ donors. The programme, from Big Brother creators Endemol, is due to be screened on Friday night.

Update: It was a hoax. Too bad.