End-of-life care

NewsBusters: WaPo's 'On Faith' Page Features Only Pro-'End-of-Life Care' Opinion
http://newsbusters.org/blogs/ken-shepherd/2009/11/07/wapos-faith-edition-features-only-pro-end-life-care-opinion

The physical body is to nurture and develop the mind, heart, and senses. The senses, heart, and mind are for the emancipation and transformation of intuition, knowledge, reason, experience, intelligence, conscience and insight. These traits form the basis for or the evolution of wisdom, compassion, and liberation. The physical body is the means for consciousness, spiritual, and the path to salvation or enlightenment: all existence is spiritual. Individual being potential for wholeness or oneness.

Spiritual is the means for higher consciousness, searching for meanings of life or existence and seeking truths in the physical and transcend or metaphysical world. Science is the art of deriving meanings and emancipation of knowledge from searching and seeking truths in the physical or material world. Spiritual is the reasoning, empirical analysis, observation, and experience of the natural world through the senses, mind, heart, and consciousness. Science is the rationalness, analysis, observation, and experience of the natural world through theory and technology. Spiritual and science are means or paths to meanings, truths, and enlightenment of natural law through the physical/metaphysical and physical world respectively. Therefore, spiritual and science are compatible and complementary to each other, or in other words, are revealing or expressing the law of nature or nature in their specific, special, and unique ways. The living or physical and spiritual worlds must adhere to or conform to or obey the law of nature, or in other words, are parts of the fabrics and essences of nature. This is neither illusion nor delusion. Individual and collective beings potential for wholeness or oneness.

It is the consciousness of all existence, particularly being or humanity, which creates such as morality, ethics, civics, belief, goodness, values, virtues, conscience, faith and reason. It is matter which nurtures consciousness. And it is consciousness which arises matter. In that sense, it is consciousness that gives rise or meanings to universal transformation, evolution, and wholeness or oneness.

Therefore, not only is end-of-life care necessary, but how it is administered and care is as critical. Care must be administered not only according to the law, moral, ethics, and civics of societies and families, but also in accordance with the moral, the free will, and the dignity of the patients. Well put in place and well organize physical, mental, and spiritual programs should take advantage of sciences, technology, social and family planning (such as love, caring, understanding, respect), and belief and faith (religious or no-religious values) to offer the up most, best care, advise and dignity not only to the patient, but also to the family. It should also be stressed that end-of-life care should provide the patient the option of guidance or being administered (the spiritual path) that end-of-life care also means planning for extension of life after the physical world or life in harmony or accordance to the law of nature. This spiritual (or oneness) path, the sooner the better, can be practiced or trained at early age in life. However, it should be offered as an option or choice for those that in the past has no interest or commitment. Therefore, in regard to spirituality, I agree with the gentlemen Deepak Chopra and those of similar convictions or truthfulness: that consciousness is part or the essence of a spirit.

If one constantly plan and prepare for things which we have ideas of, understand, or know in the physical world. Then one should be mindful and wise to plan or prepare for the after life or extension of life in the spiritual world, in particularly when one does not or cannot comprehend or aware of it and that it could be infinite or eternal. Therefore, end-of-life care programs or services could be provided as end-of-life-care or end-of-physical-life-and-beginning-of-spiritual-life (or simply life-care) as suggested by Mr. Deepak Chopra.

The physical body is to nurture and develop the mind, heart, and senses. The senses, heart, and mind are for the emancipation and transformation of intuition, knowledge, reason, experience, intelligence, conscience and insight. These traits form the basis for or the evolution of wisdom, compassion, and liberation. The physical body is the means for consciousness, spiritual, and the path to salvation or enlightenment: all existence is spiritual. Individual being potential for wholeness or oneness.

Spiritual is the means for higher consciousness, searching for meanings of life or existence and seeking truths in the physical and transcend or metaphysical world. Science is the art of deriving meanings and emancipation of knowledge from searching and seeking truths in the physical or material world. Spiritual is the reasoning, empirical analysis, observation, and experience of the natural world through the senses, mind, heart, and consciousness. Science is the rationalness, analysis, observation, and experience of the natural world through theory and technology. Spiritual and science are means or paths to meanings, truths, and enlightenment of natural law through the physical/metaphysical and physical world respectively. Therefore, spiritual and science are compatible and complementary to each other, or in other words, are revealing or expressing the law of nature or nature in their specific, special, and unique ways. The living or physical and spiritual worlds must adhere to or conform to or obey the law of nature, or in other words, are parts of the fabrics and essences of nature. This is neither illusion nor delusion. Individual and collective beings potential for wholeness or oneness.

It is the consciousness of all existence, particularly being or humanity, which creates such as morality, ethics, civics, belief, goodness, values, virtues, conscience, faith and reason. It is matter which nurtures consciousness. And it is consciousness which arises matter. In that sense, it is consciousness that gives rise or meanings to universal transformation, evolution, and wholeness or oneness.

Therefore, not only is end-of-life care necessary, but how it is administered and care is as critical. Care must be administered not only according to the law, moral, ethics, and civics of societies and families, but also in accordance with the moral, the free will, and the dignity of the patients. Well put in place and well organize physical, mental, and spiritual programs should take advantage of sciences, technology, social and family planning (such as love, caring, understanding, respect), and belief and faith (religious or no-religious values) to offer the up most, best care, advise and dignity not only to the patient, but also to the family. It should also be stressed that end-of-life care should provide the patient the option of guidance or being administered (the spiritual path) that end-of-life care also means planning for extension of life after the physical world or life in harmony or accordance to the law of nature. This spiritual (or oneness) path, the sooner the better, can be practiced or trained at early age in life. However, it should be offered as an option or choice for those that in the past has no interest or commitment. Therefore, in regard to spirituality, I agree with the gentlemen Deepak Chopra and those of similar convictions or truthfulness: that consciousness is part or the essence of a spirit.

If one constantly plan and prepare for things which we have ideas of, understand, or know in the physical world. Then one should be mindful and wise to plan or prepare for the after life or extension of life in the spiritual world, in particularly when one does not or cannot comprehend or aware of it and that it could be infinite or eternal. Therefore, end-of-life care programs or services could be provided as end-of-life-care or end-of-physical-life-and-beginning-of-spiritual-life (or simply life-care) as suggested by Mr. Deepak Chopra.

"If the government is paying for it......."

How absurd!!!

Tis the USA taxpayers aka you and me paying for universal health care!!!

Kert1,

"I am not against counselors or educators but just feel they need to be very independent of insurers and be a personal choice."

Absolutely. Insurers should not be directly providing the info or personnel. From my conversations with a few of the staffers involved in the bill, although it is not laid out in detail the intent is to assure that before the actually Medicare Reimbursement (and we are talking about Medicare reimbursemetn for the counselling, not other insurance compnaies) that a variety of Medical ethicists from a wide range of viewpoints, psychologists, AARP, eldercare specialists, and the like would develop a concise game plan and talking points, as well as guidlines and standards for the counsellors.

"How can standards be made up to accommodate every culture, religion, and preference."

It can't. It would cover the general issues and set up standard legal rules. Religious issues would NOT be part of it. It is the obligation of the individual to talk to their cleric if they so choose.

"Besides the fact the standards would be created by the same bureaucracy than runs the insurance."
No they would not, as I previously addressed.

"Well my main concern isn’t the doctors, although that could change if everyone gets paid through the same insurance... I’m concerned about counselors hired by insurance companies to advise us on how to handle “end-of-life” care, mainly issues of death. I still haven’t seen a good reason or example of how this would work today."

As I previously stated the insurance companies would nto be allowed to be involved in this. Only the doctors (and they would be shielded from influence from Medicare which is the only "Insurance company" involved)

"I am actually quite shocked you would say this, especially working so closely with these people. I can’t believe anyone would want to remove the end-of-life decision making to a independent person. It seems that you may be tainted by some of the bad experiences you’ve had hear. Let me just assure you that this isn’t generally the case. These issues are often contentious but I can’t see anyone I know ever making a fight like you described. It is too bad you had to witness this. I hope that you’ll be able to trust your family with these issues when the arise. I know I can trust mine."

Luckily my entire family (and most of my friends) are on the same page as I am about this. I set up my Living will and Health Care Agent paperwork into effect when I was 25 (over 25 years ago). And nothing has changed about it.

"I do understand that all family isn’t trustworthy but to think they see you as a financial interest is quite harsh."
I do not belive this about all family, but I have seen it enough times to want the option of independent help be available.

"I hope this isn’t how you feel."
Depends on the family. I have seen great families, ok ones and lousy ones. I have also seen nice families who could nto deal with the issue so the individual had to go outside of the family and make thier own decisions (which included not having a family member act as health care agent to spare the family the responsbility in trying times.) I am the primary health care agent (you should always have two backup agents listed in case your primary agent dies first or is incapacitated) for five people because they knwo that they can trust me to act according to their desires. It is a hard job, but IMHO, is one way that I show them that I care about them.

"I assume relatives that aren’t trustworthy will be removed from the process."
Unfortunately that is not always the case. Also one thing that you seem a bit confused abuot is exactly what the counsellor/adviser/educator does. They may, if asked, help set up the peperwork. Butmostly they judt lay out the options, and let the individual execute the paperwork on their own. My understanding of the bill provides just that process. And the intent of the bill (and what the actual detail process will include) as I have been told about it, is that the counsellor is to advise the individual on the option and actually recommend that the person first talk it over with family and/or friends. Unfortuantely, much of the detail stuff is not in the bill (or it would end up being 100,000 pages long.)

"That is why we advise doing this early on."

Agreed. Ideally one would execute their first set of these papers as soon as they turn 18. And then have at least a five year review (most people I know review it annually). Now doing it at that age is NOT covered by the bill but it is still a good idea. I did all the work myself (a little harder before the internet but still doable) and made sure that all my healthcare providers, a few clsoe family members and friends, and my attorney all had copies. I also created a card that I carry with me at all times that states that I have a living will and healthcare agent and gives the names and contact info for those people.

"May God bless as you help those who need it."
Thank you.

"Maybe we’ll get a good end-of-life policy yet!"

Agreed. We just need to keep the religious fanatics at bay.

But the cost issue is important. Not as a moral one but as a pragmatic one. Do indigents have less choice if we make the free market the arbiter of end of life services? If you choose to keep getting life support, then does the provider have the right to lien your home and estate?

If the government is paying for it, doesn't the government have an obligation to spend resources well: more money for preventative care and less for heroic measures?

The difference between moral and civic comes up. A person has a moral duty to their own ethics. A government has a civic duty to its citizens. One can argue a person should not kill, but the government is empowered by us to war. The civic duty of the government is to control resources for the societies gain. That may mean no money for transplants, end of life care, ICUs, etc. (Of course the private sector would then have a built in market to sell to in complement to government plans.)

hariaum

"But the moral question is should we participate in our own and each other's dying."
I would posit that there is no one answer for that question. While one person might feel that it is moral to end one's life under the circumstances given another might not. That is why the government has no business prohibiting a person from having help (if THEY have chosen to end their life when they are slowly dying or not living in what they themselves consider "dignity" [some elderly people would say the being in a nursing home is not liviing with dignity and that they have a right to end thier own lives.)

"The civic question is who should pay for it."

Actually that is not a relevant issue. I have never heard of a person who wanted to die with dignity who would not willlingly pay for the drugs needed.

"The moral question points to a gray zone between passively allowing death and actively causing it."

I do not think that here is a grey zone If the person makes their own choice and simply asks for help. I can assure that are humane doctors out there would would help IF they knew that they were fulfilling the person's actual wishes.

"But Polyanna sweatness aside, if I have the power to save a life, and I fail to use that power, I think the moral implication is that I am responsible for that action. (I may not want to keep Hitler or the Pope alive but I would still be responsible.) "

I would argue that it is immoral to help Hitler live if you can simply walk away from his accident. Also there is the question if you have a choice to save jsut one or two lives and have to let others die. But both issues are not relevant to the issue(s) at hand. The ONLY issues at hand are related to end-of-life decisions that one makes for oneself or that one is helping another to fulfill. If a person has either stated or written down that they would want to have all the possible medical treatments to keep them alive as long as possible, then one should try to help that. But if they have stated that they do not want such measures, one has no right to prolong their life.

"If I have the power, I can put you in jail, I can make you comply with my morality of antisuicide, or I can hook you up to feeding tubes and life support, put you in a coma and keep you around for decades. Is that right?"

No it s not correct or moral. Several friends of mine and I have all written out statements (after the government illegally interfered in the Terry Schiavo case) stating that if we end up in a persistent vegetative state and another person tries to keep us alive, that we want money from our estate used to hire a hitman to kill the interfering jerk(s). Now we all know that what we wrote is not legally enforceable (irt was our way of saying to others to not interfere with our wishes and we reject their garbage religious beliefs), but our basic idea was that those of us left should pursue that person and make their lives miserable and even pursue civil action against them if possible, with any recovered funds given to the Final Exit Network.

Once again, right wingers/left wingers have no influence on your death wishes as long as you have an advance health directive. (The recent Medicare brochure sent out to all participants has an easy to read section on this).

From Wikipedia:

"Advance health care directives, also known as living wills, advance directives, or advance decisions, are instructions given by individuals specifying what actions should be taken for their health in the event that they are no longer able to make decisions due to illness or incapacity.

A living will is one form of advance directive, leaving instructions for treatment.

Another form authorizes a specific type of power of attorney or health care proxy, where someone is appointed by the individual to make decisions on their behalf when they are incapacitated. People may also have a combination of both.

It is often encouraged that people complete both documents to provide the most comprehensive guidance regarding their care."

COMPCHIRO,
I would like to point out before I get into detail that I think what you are doing now is a very noble thing and I appreciate you insight into the topic. I should also mention, I am probably not talking about what you currently work with in end-of-life counseling. My concern is for what the government has proposed. I would like to point out that they may end up being very different things. I don’t think anyone really understands all the consequences of this Health Bill that has been proposed.
I hope you weren’t offended by the naïve comment. I was simply referring to the post and not you as a person. You clearly do have more some good knowledge on the subject and I appreciate you clearing that up.
I think your understanding of counseling may be different than mine. I understand what you are saying but counsel is advice or opinion, not merely education and Webster’s backs me up on this. Perhaps what you are referring to isn’t really counseling but just one on one education. I am not against counselors or educators but just feel they need to be very independent of insurers and be a personal choice.
I agree we need standards but I think this is too complicated. How can standards be made up to accommodate every culture, religion, and preference. Besides the fact the standards would be created by the same bureaucracy than runs the insurance. I just can’t see this being advantageous to us.
“I have seen doctors give this advise when asked. And NEVER has there been a conflict of interest.”
Well my main concern isn’t the doctors, although that could change if everyone gets paid through the same insurance, but that isn’t the point. I’m concerned about counselors hired by insurance companies to advise us on how to handle “end-of-life” care, mainly issues of death. I still haven’t seen a good reason or example of how this would work today.
“‘The people that should be helping in end-of-life matters should be the one that are closest to us.’
Not Really”
I am actually quite shocked you would say this, especially working so closely with these people. I can’t believe anyone would want to remove the end-of-life decision making to a independent person. It seems that you may be tainted by some of the bad experiences you’ve had hear. Let me just assure you that this isn’t generally the case. These issues are often contentious but I can’t see anyone I know ever making a fight like you described. It is too bad you had to witness this. I hope that you’ll be able to trust your family with these issues when the arise. I know I can trust mine.
I do understand that all family isn’t trustworthy but to think they see you as a financial interest is quite harsh. I hope this isn’t how you feel. I assume relatives that aren’t trustworthy will be removed from the process. That is why we advise doing this early on.
May God bless as you help those who need it. Maybe we’ll get a good end-of-life policy yet!

The question as posed is not really a moral one. It is empirical and can be answered (and has been answered).

But the moral question is should we participate in our own and each other's dying. The civic question is who should pay for it.

The moral question points to a gray zone between passively allowing death and actively causing it. In a world of wars, it is hard to argue that we do not commonly make the moral decision to speed death. We make a sweat distinction between letting someone die v killing them (but we don't mind killing them when it is in our interest). But Polyanna sweatness aside, if I have the power to save a life, and I fail to use that power, I think the moral implication is that I am responsible for that action. (I may not want to keep Hitler or the Pope alive but I would still be responsible.)

But we also respect autonomy. If you want to die, how responsible am I to stop you? If I have the power, I can put you in jail, I can make you comply with my morality of antisuicide, or I can hook you up to feeding tubes and life support, put you in a coma and keep you around for decades. Is that right? If we respect autonomy it is not right. The argument against suicide is that it is not an autonomous decision - poor thinking is often underlying the choice. But if good thinking underlies the choice (you are terminal with an illness and about to experience horrible pain), do I not have an obligation to let you do what you want to do? And then, if I can help shouldn't I?

The civic question is kind of funny. The right wingers want the government to pay for keeping bodies alive for ever. If they let the market place do its thing, people would be dying at two days in an ICU. So I guess the right wingers are arguing for more socialized health care without responsible stewardship of our tax moneys. Funny.

hariaum

Kert1,

"I think you might be a little naïve in your approach to this topic."

Actually I am quite knowledgable on this topic having both dealt with it personally and taught others about it.

"Counseling someone involves more than just educating them."
At its core it is education.

"If they just wanted to educate they would provide information or send people to class."
Since this topic is very personal and every person has individual issues involved sending literature or attending a classs is not enough. There already is info around but having seen and heard many people ask questions that the literature does not answer, a counsellor is needed.

"Counselors actually give advice and help shape our thinking. For instance, a financial counselor doesn’t just educate us on investments they advise us on the best places to invest, hopefully giving us the final say. That is why there is a big difference between a good counselor and a bad one. We allow them to direct us in matters where we trust them."

That is why there needs to be detailed standards devloped.

"What you propose in your post doesn’t sound bad but I think it only scratches the surface of what is going on. We need to fully understand the consequences of this unprecedented change. The truth is that the main concern of “end-of-life” issues is dying and these counselors will advise people on what to do, as any counselor would. The problem is the counselor works for the same person (aka the government in this case) as the insurance company. Even the educational materials could push someone in one direction or another. "

Again, that is why it needed to be carefully developed.

I never said that it is easy. I simply said that it is needed.

"It is very easy to see the conflict of interest here."
I have seen doctors give this advise when asked. And NEVER has there been a conflict of interest.

"The people that should be helping in end-of-life matters should be the one that are closest to us."
Not really. I have seen many people dealing with this issue have children or family members who could not deal with it or had their own selfish reasons for giving incomplete or even bad advise. Also I saw two people who were trying to make these decisions (who were non-religious ) being harrased by some of thier children bcause of those children's religious beliefs. The children screamed at their parents that "god says this (garbage) and that (garbage)". Also that the children would stop the parents from ending thier lives. The end result was that independent advisers had to help the parents set up power-of-attorney and health care directives that specifically excluded the psychotic kids. On a side note those kids ended up being completely cut out of thier parent's estates (both of which were worth several million.) But I do agree that one needs to get advise from someone you trust, it is jsut that hopefully your doctor is trustworhty. And then you need to give it careful thought.

"I would never accept “free” advice from someone that has a financial interest in me"
Then you should not accept advise form your family since they have a financial interest in you too.

" and I don’t know why anyone else would either."
See above.

ONESTRING,
I’m not sure if you completely read my post but I very purposefully and skillfully avoided the term “Death Panel”. Currently I don’t find the term very meaningful or useful. Unfortunately people like to throw around ideas they neither understand nor care to understand and avoid the issues. I choose to discuss the issues.

I’m not sure if you understood what I put in my post. If you read it again you’ll see that I clearly recommend we have our “end-of-life” issues in order, especially as death inevitably draws closer. My main point is we only trust our closest relatives and friends with these issues, as we would any other important issue. Makes sense to me.

I actually agree enthusiastically with most of you post on this. You clearly have personally thought this out. I’m just not sure who you are arguing with.

I also don’t understand why you reference fear. I know it is a popular term these days but I don’t think we need to throw the term around. I believe in friendly debate over important issues. We should know and understand things when we have 2000 pages of healthcare legislation to digest.

COMPCHIRO,
I think you might be a little naïve in your approach to this topic. Counseling someone involves more than just educating them. If they just wanted to educate they would provide information or send people to class. Counselors actually give advice and help shape our thinking. For instance, a financial counselor doesn’t just educate us on investments they advise us on the best places to invest, hopefully giving us the final say. That is why there is a big difference between a good counselor and a bad one. We allow them to direct us in matters where we trust them.

What you propose in your post doesn’t sound bad but I think it only scratches the surface of what is going on. We need to fully understand the consequences of this unprecedented change. The truth is that the main concern of “end-of-life” issues is dying and these counselors will advise people on what to do, as any counselor would. The problem is the counselor works for the same person (aka the government in this case) as the insurance company. Even the educational materials could push someone in one direction or another.

It is very easy to see the conflict of interest here. The people that should be helping in end-of-life matters should be the one that are closest to us. I would never accept “free” advice from someone that has a financial interest in me and I don’t know why anyone else would either.

There is an ongoing bout of misinformation about what is being put forth here.

There are idiots who say that what is being advanced are "death panels". Those people can and should be ignored as the mindless idiots they are.

There are those who mistakenly think that what is being advanced is the notion that health care professionals will be only advising people to end their lives. One can only hope that those people are honestly mistaken and can be educated.

There are those who have been misguided into thinking that granny will be thrown under the bus.

What IS being advanced is the Medicare providing (every five years) the OPTION of a paid consulation with one's healthcare provider about the VARIETY OF Options out there AND the educatrion about what Living Wills and Health Care Agent directives are. Nowhere in the ideas being put forth does it direct that the doctors or patients decide to end thier lives or give up their right to request every last chance and medical option be used if they are dying.

What is being put forth is the government help EDUCATE people about the various options out there and then let them decide what route to take. Only a fool would see that as a bad thing.

Should a person go on trying to live--by medical means of course--after it is quite obvious that quality of life has declined to the point that really there is no life left to live there?

My answer to this is unequivocal: No. A person should not try to live beyond the point any sensible person can see is the last remaining point between worthwhile life and just suffering and helplessness. A person should have a certain self-respect. It seems so selfish and craven to go on hanging on, driving up medical bills, and teaching to one's relatives--and friends, acquaintances, doctors and nurses--that death is so terrible, that a person just cannot face it, and that the correct procedure is to head in the direction of more and more medicine, for pain physical and otherwise--not to mention medicine which is supposed to...what? Cure one?

In fact it is arguable that we should routinely celebrate those who have made the most of their lives, even if the life they led resulted in premature death. But if this is going too far, still, every person should be taught to make the most of his or her life and that trying to hang on and drag out life is no substitute for a life well lived. But this could very well be only my opinion because I feel I am becoming reconciled to my death. In fact I have thought about it to where I hold a position concerning such (and life as well) which is neither religious in the traditional sense nor atheistic.

I believe there is intelligence and morality behind the creation of the universe but that such is always a project for the human race to understand and that commands from God or even current scientific evidence is no substitute for continuing to learn about the universe. This intelligence and morality I believe in is always ahead of us, we are never equal to it, and it is a gross error to think we understand such to the point of erecting a religion which all must follow--and a gross error as well to set up scientific evidence as if it is absolute, never to be superceded. Everything is always ahead of us. We never know more than "something" or a "little" now. No use in trying to pound into people's heads one's pet religion or pet scientific evidence.

I have come to this conclusion after studying both the positions of the religious and the atheists. The monotheistic religions of Judaism, Islam and Christianity allow for little modification in understanding the origin and meaning and morality of the universe if any modification at all. Here it is agreed morality and intelligence is behind the creation of the universe but concerning such all is supposedly settled! God forbid anyone would have any other interpretation of the intelligence and morality behind the universe than that which we are supposed to believe in and follow! And Hinduism and Buddhism are really no better what with hypotheticals such as reincarnation and the possibility of escaping rebirth and the notion of reaching a position called "nibbana" which is suspiciously like believing one can become God. All religions approach things as if all is settled and that one must only follow. There has never been a religion it seems which says merely that all remains to be discovered. Hopefully the latter is something of the project of science.

I really have no problem with science. In fact I love it. But I reject the more dogmatic scientific minds. It would not surprise me a bit if so much of what we know now is incorrect by future standards. And I have a problem with scientific views when they are enveloped by the atheistic view. I have a big problem with the atheistic view. Atheists of course are not given to religion--not even Buddhism although some try to distinguish Buddhism from religion and call it a philosophy compatible with the atheistic view. Compatible with the atheistic view when one is supposedly constantly reborn (and there is no evidence of that) and that one can never escape this until one reaches perfect enlightenment by which rebirth is extinguished? Perhaps no overt belief in God here, but certainly something of the belief that one can become God what with enlightenment and all.

But to get to the point about my problem with atheists, they are perfectly correct to be against the settled positions of the religious, perfectly correct to be against all which arrests the pursuit of knowledge, but they get themselves into an obvious contradiction when in eliminating God they go to such an extreme they say there is exactly nothing behind the creation of the universe and life. No God, no intelligence, no morality. They get into an obvious contradiction because in saying such things as everything blindly self-organized they undercut their constant call for an increase of intelligence--an increase of science especially--over ignorance, especially the ignorance of the religious.

In other words, if everything arose without the slightest bit of intelligence behind it why should we particularly care about intelligence as the atheists constantly ask us to do? If all arose from nothing then human intelligence is at best a petty conceit, a piece of local self-flattery in a vast universe. With nothing behind the creation of the universe there is no reason at all to pursue intelligence. The universe apparently does quite well for itself without intelligence--in fact it has done virtually everything!--so why should we pursue intelligence, what makes it so important? In fact we should arguably work toward becoming more ignorant, for that would be more in tune with the universe that has nothing behind it--more in tune with the blind drives which have created the universe and life.

Certainly with nothing behind the universe intelligence is at least an anomaly and probably an aberration. Something to be removed rather than admired. In other words the atheists go to the opposite extreme of the religious. The religious treat everything as definitively understood, that all one must do is follow. The religious do hold that there is intelligence behind the universe but they also hold that concerning such all is settled--we have our commands and must obey them. The atheists understandably recoiling against this eliminate intelligence behind the universe completely--but then they also lose their rationale for asking us to become more intelligent and overcome ignorance. My solution is that there is indeed intelligence behind the universe--morality as well--but that the bulk of the knowledge concerning such is always ahead of us, nothing is really settled.

There is no compelling reason to make people slavish followers of a religion or a particular scientific theory for that matter. All is ahead of us. And this is why I am reconciled to my death. I believe in the intelligence behind things. This does not necessarily mean life after death but that one can learn and enjoy--there is so much to be known. One can live a full life. And at the end of the day tell everyone to keep pursuing--to never give up. And supposing people always do such and keep succeeding, then there will always be life after death.--THIS life, which we should never try to prolong if it falls below a certain level of quality. In fact we should never try to make acceptable a lower quality of life but always try to increase the quality. And this we can call life after death.

Now I lay me down to sleep and pray the Lord my soul to keep. If I should die before I wake I pray it goes this way for my sake... If not I have already decided and directed in case I should linger. No meds but pain meds and family and friends to comfort as I pass on. At 72 and in bad health I am really anxious to meet up with God. Don't take that away from me. :)

I believe that people do abandon old people. It is extremely sad to see-. So it is true. If we exert all effort to extend life- and then betray and abandon those old people- what is the point?

Also, have you been to an Alzheimer's unit in a nursing home? THese people are so far gone- it is my worst nightmare for my body to outlive my mind- huge panic at the idea- what is right there? I do not wish to live like that at all. While not able to think or talk I believe one could still suffer...

Further- I have seen morphine used quietly to hasten death when someone is in the last days- so the argument is sort of mute - isn't it- about that.
Things to think about. The question remains on WHEN and by whose choice...
More to think about.

kert1 is unfortunately one of those folks who believed the republican party's false propaganda about "DEATH PANELS".

This 17 yr veteran former financial consultant would like to remind everyone that there is ALWAYS a need for end of life counseling.

Taxes, inheritence, gifts to charity, who cares for the cat, who will clean out the residence, what kind of funeral, what type of wake if any, messages and wisdom for those left behind, desires for "pulling the plug or not", religious rites, etc,etc,etc,etc.

Let us also remember that death taxes can be avoided only by planning ...in advance of one's death.

It is infuriating when bloviators and faux news people (and legit newspeople for that matter) inject politics, un-needed FEAR, and suspicion into these very serious issues that simply must be decided in the cold light of day with all loving care, and respect possible. These issues are decided every single day in private homes and offices all over America.

You want to send our finest men and women into battle without a discussion of how their children will be cared for,or their last wishes? Or how they will be buried? REALLY? Oh, you DO think they should get that kind of respect and attention? Well of course they should!

OK. THAT is end of life counseling courtesy of the US government going on NOW, as it should, in our millitary.

QUIT SCARING THE ELDERLY AND INNOCENT BY LYING ABOUT NON-EXISTENT SO-CALLED "DEATH PANELS"!

Interesting topic. But the "comments" section sabotaged by a weirdo. Isn't there a
way for Washington Post to monitor them. Fully support individuals' right to express views. But gibberish?

Hmmm, a new way for devastatetownpost, JJ, the Blog-lady et al to "hog a blog"??? How sad and strange this person is.

Does end-of-life care prolong life or does it prolong suffering?

It depends the specific situation and procedures taken to prolong a life. Some procedures requires patients to stay conscious and feels a degree of discomfort while others do not. More study and reports need to be published to educate people on different procedures so they can make the optimal decision for themselves. I would personally love to have the information handy.

Should it be a part of health-care reform? To make it affordable for more people, the answer is yes.

This is exactly why everyone should have an advance health directive. (and the cost to set up one should be part of any universal health care bill).

"Advance health care directives, also known as living wills, advance directives, or advance decisions, are instructions given by individuals specifying what actions should be taken for their health in the event that they are no longer able to make decisions due to illness or incapacity.

A living will is one form of advance directive, leaving instructions for treatment.

Another form authorizes a specific type of power of attorney or health care proxy, where someone is appointed by the individual to make decisions on their behalf when they are incapacitated. People may also have a combination of both.

It is often encouraged that people complete both documents to provide the most comprehensive guidance regarding their care."

The idea of "end-of-life" counseling is not bad, and there is some good in it. I believe all people should discuss end-of-life issues with their closest friends and relatives to make sure people are respected and needs are met by all. This seems mostly like common sense. The real issue here, that isn't mentioned in the questions, is government sponsored "end-of-life" counseling. One can only imagine the abuses that could arise from this conflict of interest.

I think this makes about as much sense as trusting a car dealership to advise us on how much money to spend on a car. Certainly there is no reason to believe they would just serve their own purpose: making more money off from me. While they might be honest, there is no reason for me to trus them.

I see the following reasons to stay away from this type of government involvement.

1. There isn't enough money to cover health care, so we are always looking for ways to cut back. This is just a fact of life we need to deal with.

2. The weak and powerless are often the ones to miss out. Someone near the end of their life is truely the most vulnerable of people. It's not like they are taken advantage enough.

3. We should trust no one but our closest friends and relatives to such vulnerable people. Not that everyone is evil but there is too much at stake here.

4. There is a definite lack of freedom when the government starts having a say on what happens when we die. I can't imagine feeling comfortable with this.

Can you imagine a prviate insurer sending a couselor to your ailing mother and giving advice on her end-of-life care? If I heard of that, I would get rid of them as fast as I could. Let's make sure the government does not try to stick their nose in where it doesn't belong. These issues are for those who care for the individual.