Upcoming San Francisco Volunteer Training Aug. 18

Hello Northern Californians!

In case you haven’t already heard, we want you to know about an upcoming fabulous opportunity.  We have scheduled our first northern California volunteer training in San Francisco for Sunday, August 18 from 10 am – 4 pm (includes lunch).  We still have four seats left to fill and would love anyone interested to join us!

Information About our Volunteer Teams

Client Advocate Volunteers provide the following services:

  • Thoroughly explain all the different options for dying well and how to achieve them; including stopping life-preserving medical treatments, seeking palliative care, entering hospice, voluntary stopping eating and drinking with the support of hospice, palliative sedation, and medical aid in dying.
  • Help people navigate through their dying process, from beginning to end. Sometimes this takes days, sometimes weeks or months: sometimes 1-2 meetings, sometimes many more.
  • Advocacy and support for clients whose wishes are not being met or who are not getting adequate pain or symptom management.
  • Meet with families to help facilitate discussions about the client’s end-of-life wishes.
  • Provide information and support to family members regarding the process of their loved one’s dying, what to expect and how they can best provide compassionate and helpful support.
  • Provide support and reassurance to the client as he/she navigates their way through the process of accessing medical aid in dying and encouraging the client/family to advocate for themselves. We are willing also to advocate for them if necessary, such as helping the client find physicians willing to prescribe and facilitate a conversation with physicians or hospice to help clients get needed services or adequate pain control.
  • We are able to bring an experienced, calm, peaceful and reassuring presence on the day of planned death, to help review instructions and provide moral support and comfort to both the client and family.
  • Assist in completing or understanding advance directives.

Our EOLCCA volunteers also can be trained to provide educational presentations to hospices, community groups and others to help the public understand about ALL their end of life options.

Please complete a Client Advocate Volunteer application by August 10.  Once it is received, we will contact you with additional information including the location and address of the training session.  Please contact us if you have any questions or would like more information. We’d love to talk with you.

An Act of Love

I was talking with my friend, Jen, today and she told  me about the death of her 96 year old grandmother. There were some important things she shared with me about the good death her grandmother had and the comfort she received from that experience.  

The first was when her grandmother was dying. Jen said that the day before her grandma died, she was visiting her and she looked like Grandma: beautiful skin, pink lips, bright blue eyes, shiny hair. However, she had congestive heart failure and as she was dying, her lungs were filling with fluid and she was having difficulty breathing. Her hospice staff put her on medication to calm and relax her through that process. Jen came back the next day to visit and was shocked and astounded by the change she saw. Grandma no longer was glowing. 

 

Her lips were pale, her face was gray. Even her hair looked different. And Jen realized in that moment that her grandmother was already gone and her body was just trying to catch up and leave too.  

While Jen admitted this was the scary thing about death; that people leave us, she wisely realized and accepted we all go at some time. None of us avoids death. It is part of everyone’s life journey. And that gave her hope.  She realized death wasn’t as scary as she thought. She understood that death is a part of life and that there are steps she can take to be prepared and communicate her wishes to her family and loved ones well in advance.

And with that new understanding, she realized that her grandmother had given her this gift too, by planning ahead. At about 85 years old, Grandma had sent Jen copies of her Advance Directive: including her living will, her medical proxy, and her DNR. She had explained them all to Jen. She had told Jen she wanted to die a natural death, at home, with comfort support only.  

Jen said, “Grandma sending me all those documents and talking to me about it was an act of love.”  I asked her what she meant. She explained that by knowing her grandmother’s wishes, and by knowing what to do next and where the bank statements and the will were, and how and where she wanted to be buried, and how she wanted to die, that Jen and her family didn’t have to worry about any of those details.. They already had the answers. Because of that, they were all able to be fully present with Grandma when she died. And to see, really see, the peaceful transition she went through as she died.  

Jen said it was a beautiful death and experience, and it made her less fearful of her own death.  She has since completed her own Advance Care Planning documents and shared them with her husband, parents, and siblings. Another act of love.

 

End of Life Choices California has trained volunteers who will give a free presentation for your group, large or small, about planning for a good death, and all the other things around dying that are important to plan for.  Check out our website for more information about Advance Directives and all the supporting documents. Our volunteers will also meet with you individually and help you understand the forms and how to fill them out.  Please call 760.636.8009 or email info@endoflifechoicesca.org if you have any questions or to schedule a volunteer.

This Belongs at the Top of Your Summer Reading List

“A straightforward, well-organized, nondepressing guide to managing the run-up to one’s inevitable demise.”

Amanda Urban, Publisher’s Weekly

 

“The surprising comfort of a new book about death”

Michael Dirda, The Washington Post

No, you won’t survive your death, but you can live until the very last moment without the pain and humiliation that inevitably accompany an over-medicalized dying process.” 

Barbara Ehrenreich, author of Natural Causes

She’s done it again. 

New York Times best-selling author of Knocking on Heaven’s Door, Katy Butler, has penned a stunningly effective and sublimely practical compendium on how to create a good end-of-life. Something few think about, but everyone encounters. 

Ms. Butler offers her readers uncommon insights drawn from her own experience of helping her parents pass peacefully. You’ll discover complex ideas to ponder along with critical steps to follow as you or a loved one contemplate your final approach to the mystery of life. Death. 

She shares inspiring stories. She answers primal questions about weighing medical risks; preparing your family; avoiding a hospital emergency room; building resilience and creativity; tackling essential paperwork and settling your affairs and taking advantage of choices available to you. In California, we can turn to the End-Of-Life Option Act to guide our path. And to End-Of-Life Choices of California (EOLCCA) to gain access to vital information and deeply personal support when needed.

Filled with case studies and real-world examples of both good and bad outcomes, The Art of Dying Well delivers excellent resources to navigate our very complex medical system. Pay close attention to “Ways to Prepare” in every chapter, along with her excellent section on “Coping with Dementia.” Here, she even provides us with an outstanding dementia directive letter.

In Chapter 4, Awareness of Mortality, Ms. Butler presents an efficient tool to enable you to face a serious diagnosis with a poor prognosis: “Understanding the Trajectory of Your Illness.” She encourages us to use this pen-and-paper method to improve understanding, command of details, and to reduce our feelings of helplessness. What’s more, a physician is likely to respond well to your finished product because it will be concrete yet editable.

Ever-Growing Movement

Ms. Butler takes a gently adversarial approach to our health care system with justification. She was dragged “through the mill” with her parents’ long and convoluted illnesses. Her deep and wide research on the business of dying puts her in a league of frontline experts in this ever-growing movement of end-of-life choices and dignity in death.

Author and Advocate, Katy Butler

Further, she staunchly advocates for patients and their families to be seen, heard and understood.  

If you do not have a family member or friend to advocate for you, begin by reading and rereading this book. Mark the pages with sticky notes. Jot down questions in the margins. Take it with you to doctor visits. Consider The Art of Dying Well as your surrogate advocate until you can gather your human network.

 

Giving Life Meaning

In the beautiful spirit of Atul Gawande in Being Mortal, Ms. Butler urges us to clarify over and over what’s important to us, what gives our lives meaning, and to live those values daily. Until we can’t. She counsels us to compel the medical community to hear us, to act in our self-interest, not theirs. If not, we’re empowered to find another doctor or request a palliative care consult. 

Finally, I enjoyed the inventive ways Ms. Butler explains to successfully age in place, why picking a younger doctor matters, how to communicate honestly with medical professionals, and how to make your death a sacred rite of passage rather than a medical event.  

The Art of Dying Well belongs at the top of your summer reading list.

 

Article by Lynne Calkins
Edited by Carolyn L. Smith

 

Dealing with Dementia: What Do I Do?

 Alzheimer’s disease is one of the most common health problems people face in their seventies and eighties. However, did you know you can take certain measures before such a diagnosis to ease such a transition for yourself, your family, and your caregivers?

Let’s look at what we’re up against with a few eye-opening facts  by the  Alzheimer’s Association on the disease no one wants to think about:

  • Alzheimer’s disease ranks as the sixth leading cause of death in the United States.
  • Alzheimer’s disease eclipsed heart disease by a staggering increase of 145 percent compared to heart disease, which decreased by nine percent between 2000 and 2017.
  • 1 in 3 seniors dies from Alzheimer’s or other forms of dementia—more than breast cancer and prostate cancer combined.
  • More than 16 million Americans provide support as unpaid caregivers for people with dementias—that’s nearly five percent of the American population, equating to 18.5 billion hours in care, valued at nearly $234 billion.

Do you find these statistics as startling as I do?

To me, the scariest aspect of a dementia or Alzheimer’s diagnosis would be the slow but overwhelming loss of my memories. Of my family. My friends. My experiences. My life.

I can’t imagine being alive and not able to recognize the people and places I love.  Heart-breaking.  

Thankfully, we have some control over the impact of such a diagnosis.

First, tell the people destined to care for you the type of medical care you want if dementia becomes a reality. Please take a moment to study and complete the Dementia Directive. You can find it here.    With it, you access the opportunity to declare what matters to you when you can no longer speak for yourself. And while you’re at it, make sure you have filled out an Advance Directive with other medical wishes, and share it with your family, your physician, and update it annually. You can find the appropriate forms here for Advance Care Planning on our website. 

We also suggest you make a video of yourself (fairly simple on a smartphone) stating explicitly what you wish to happen and not to happen during this time. For example, if I have advanced dementia I do not wish curative treatment for any other illness or disease that might arise, in order to more quickly help me experience a peaceful death. This could range from a recurrent  bladder infection to a cancerous tumor. I would choose comfort care only and make sure my spouse and physician understood exactly what I mean by that term. You may choose differently. 

Have you given it any thought? 

 

Personally, I want to do anything and everything I can to PREVENT the disease rather than wait until it arrives.  Studies clearly demonstrate that we begin developing signs of dementia/Alzheimer’s long before symptoms occur. 

As a retired naturopathic family physician, I am trained to think about prevention. Regrettably, medicine currently knows of very few, if any, treatments for Alzheimer’s disease and other dementia diseases.  

For all these reasons, I feel compelled to share a TED Talk with you that opened a new line of thinking for me. I hope it will provide comfort for you, too.

 

On the Resources page of our website, we list the Oscar-winning movie, Still Alice, starring Julianne Moore, developed out of an amazing book written by neuroscientist and best-selling author, Lisa Genova. Her TED Talk on how to prevent Alzheimer’s disease will instill hope in you. Once exposed to her message, you’ll understand why and how to help your brain develop a bank of healthy cells and a thriving network of new neural pathways.

For me, in order to increase my neuroplasticity, I have decided to learn to speak French. Pourquois pas?  And in the meantime, I will complete my Dementia Provision, review it with my spouse and physician, and update it annually to account for life’s changes. 

 

Au revoir, mes amis.

The Elephant In The Room

Photo Credit: Bizarro Comics

CAN WE TALK ABOUT DYING?

By Lynne Calkins

“Make friends with death. Get comfortable with it, and you will have a much fuller, happier life.”  Seriously? Sounds kind of weird, doesn’t it? Who wants to be friends with such a taboo subject? Sounds kind of scary, maybe makes us a little sad.

Death is definitely “the elephant in the room” that no one wants to talk about, especially while we are young and healthy but also when a loved one is seriously ill.

I recently heard Dr. Bob Uslander, of Integrated MD Care in Del Mar, CA (and a member of End of Life Choices California’s Advisory Board) whom I greatly admire say, “make friends with death” on his regular podcast.  Dr. Uslander is considered an expert on death and dying and living. He is a palliative care physician who helps people with chronic, serious illnesses feel as good as possible and enjoy the last chapter of their lives as much as possible.  Often, these are people who, even though they do not want to die, accept that it is inevitable, and they talk about their dying, that “elephant in the room,” and how they envision it. They have taken control over their dying; they feel lighter, empowered.  “Dying is the one thing we all do,” he says, so why not embrace it?

What does he mean by “get comfortable” with death?  I believe he means that because we all die, we should bring this topic out of the closet, shine a light on it, and talk about how we would want our dying to be.  I know that for me, like most people, I would like to die at home, with my husband at my side. I have talked about it aloud to my spouse and children and named the person to speak for me if I am unable to do so.  I’ve written it down in an Advance Directive (AD), signed it and had it witnessed. I have given copies to my husband, my children and my doctor; it is in my medical chart. This document clearly directs my doctor and family as to what I want if someday I cannot speak for myself.

I can honestly say that once I had done the above I immediately felt lighter, happier, and liberated; knowing that if something unexpected were to happen, and I was unconscious with no hope of recovery, my family will know what is important to me.  They will try to get me home. What my family doesn’t realize is that this gift to them helps guide them, should this situation ever occur.

There are numerous accounts of people who have said they want to die at home, but sadly, they never told their loved ones, never wrote it down, so when the time came that they were unconscious, from stroke or car accident, they died in a hospital, in an ICU, with tubes in every orifice of their body, because no one knew what they wanted, and the default went to the medical personnel.

Let’s acknowledge “the elephant in the room”:  Let’s admit that we are going to die, hopefully not soon, but that we will all eventually die.  Let’s get comfortable talking about how we would like to die, where we want to be, who we would like to be present.  Let’s have that conversation about death with our family, loved ones, and physician and get comfortable with that “elephant in the room.”  The sooner we do and write down our wishes in an Advance Directive, the more likely it is that wishes are respected. Our family and friends will be grateful to have the opportunity to help us achieve our goals.

Please go to our website  where you will find an Advance Directive form to download and complete.  Sign it, have it witnessed, and give copies to your loved ones and physician.  If you have any questions, or would like help completing an Advance Directive, please email us at info@endoflifechoicesca.org and let us know how we can help you.

With special thanks to Dan Piraro for permission to use The Elephant in the Room to help us illustrate so clearly the complexity of discussing our end of life wishes.

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Please Support Our Work

End of Life Choices California provides information and personal support regarding California’s End of Life Option Act and all other legal end-of-life options to the medical community and to the public.

National Clinicians Conference On Medical Aid In Dying

We are pleased to announce that End of Life Choices California just became an official sponsor of the first-of-its-kind National Clinicians Conference on Medical Aid in Dying taking place at University of California, Berkeley on February 14-15, 2020.  

We are very excited and proud to be part of this national gathering of clinicians and others interested in sharing knowledge and experience with each other about medical aid in dying.  

For many years, clinicians have had to work hard to find reliable information for their patients who wished to participate in their state’s law allowing medical aid in dying. This groundbreaking conference will bring together informed and compassionate healthcare practitioners to share information, resources, experiences, and best practices in the expanding field of end of life care.  

End of Life Choices California is hoping to host a panel to discuss how we help individuals and families make difficult end of life choices through our client advocate volunteer program.

For more information about our program and services, how to become a volunteer, or to schedule a speaker for your group, visit our website.  Please also share our resources with your friends, family, health care providers, and colleagues.  Hopefully we’ll see you in Berkeley next February!

Please consider making a donation to support our work.  Thank you!

 

But, Isn’t It Suicide?

When talking about medical aid in dying, the short answer?  No. Definitely not. But there is a better, more thorough answer.

The other night I was at a dinner party with eight intelligent, thoughtful people.  At some point my husband thought it was necessary to let everyone know I had become involved in starting a new non-profit organization.  He said this with great pride and of course, everyone asked, “What is this new non-profit?”. They seemed very interested and I, knowing what was coming, graciously answered by telling them about the national non-profit I used to work with that advocated for medical aid in dying laws and provided on-the-ground volunteer support to people who were facing terminal illness and death. These volunteers were trained to help them through the process, find the answers they were looking for to understand all their end-of-life choices, and if they qualified, help them access the End of Life Option Act, new to California since 2016.  I explained that this national non-profit closed down their volunteer support service last year, and a group of us decided to carry on the work here in California, on our own, and hence the new non-profit organization.

Of course, as always, the conversation stalled as people digested this information, and the gentleman to my right said “Well, that’s an uplifting dinner topic.”  I nodded my head, smiling, and everyone chuckled. Then he said, “But that’s suicide, right?”. Knowing this gentleman was a brilliant neuroscientist, I clearly and simply said “No, it’s not.”  And before I could explain, my husband, a man with excellent ears over the last few years of hearing me work with end-of-life issues, said “Suicide is driven by mental illness. Medical aid in dying is driven by a desire to control the time and place of one’s death, hoping for a peaceful death.”  Bravo, husband! He nailed it.

It’s true that many people, for many years, have thought of death with dignity or medical aid in dying as many things other than what it is.  Some of the terms we see and hear are “assisted suicide”, physician-assisted suicide”, or “euthanasia”. In this country and in the states that have legalized medical aid in dying, none of these are true.  It’s no wonder that some physicians are still uncertain and reluctant or fearful of being a prescribing physician under the law. I’m still astounded that in Oregon, after 20+ years of the Death with Dignity Act being in place, people (and physicians!) still either don’t know it exists or know nothing of how it works.  

It never fails to amaze me how much people actually do not want to talk about death.  Ever.  As if it will never happen to them.  Or that if they talk about it they might catch it and oh my gosh, then what?  But those of us who work in the field see death as just another part of life. Sure, it’s the end of our worldly life and sure, none of us really knows what comes next, but that is a personal journey to think about.  The fact is we all die. The question is “how do you WANT to die?” Many of us pass from this world without even having to think about it due to accident, trauma, quick medical deaths such as a life-taking myocardial infarction or stroke.  But a greater number, and a number getting bigger as medical technology improves, end up with chronic disease that will eventually terminate our lives. And that is where the work comes of knowing what our options are, including being able to ask our physician to write a prescription for a lethal drug if we have a terminal disease process in front of us that will steal our dignity, our self-sufficiency, our bodies and eventually our lives.  We don’t have to go down that road if we don’t want to. Or, we can travel that road as far as is acceptable to our own individual values, and then plan the day of leaving this world with our loved ones at our side, self-ingesting a dose of medication that will put us to sleep, then into a coma, and stop our heart and leave us in peace.


That is not suicide.  Suicide is a wish to die when an individual could otherwise continue to live.  There is cultural shame associated with suicide. Medical aid in dying is an intelligent, well-thought-out choice.  It is a decision to end our lives when we would otherwise wish to live, but that option is no longer available as disease is going to cause our death . There is no shame in that.  

End of Life Choices California came into being to provide sound information and personal support to people facing the end of life, either with serious or terminal illness.  There are many choices. They are spelled out on our website. I have no particular bias towards one choice or another. As a retired physician, I believe it is the patient’s right to choose what is right for themselves.  I have no idea what I would personally choose if I received a terminal diagnosis.

I think we can’t know until we truly walk in those shoes. But it gives me hope and peace of mind that I have options available to me and can choose medical aid in dying if I feel it is right for me.  

An interesting fact out of Oregon and Washington is that of all terminally ill people who qualify under the law and receive a prescription, only about two-thirds of them end up actually taking the medication.  They gain so much peace of mind and lessening of anxiety by having that medication readily accessible that they often are then able to relax into their dying process and never take the medication. I think this is an excellent example of successful palliative care.  

So no, medical aid in dying is not suicide, not by a long shot.  

End of Life Choices California is committed to being there when and if people need us. Our volunteer services are available at no charge to anyone.  We hope you will reach out to us via email or call (760-636-8009) with any questions.  Please share this information with people you know, people you love and your medical professionals.  And, if you are feeling generous, we would certainly welcome any donation to support our work. We are happy to give presentations to groups, large and small.  We wish you peace on your journey.

 

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Please Support Our Work

End of Life Choices California provides information and personal support regarding California’s End of Life Option Act and all other legal end-of-life options to the medical community and to the public.

Client Advocate Volunteer Training Program Launched

EOLCCA inaugurated its first Client Advocate Volunteer Training program on June 2, 2019 in Tarzana, CA.  We spent a fact-filled day training four wonderful volunteers from the Los Angeles and San Diego areas, sharing information and reviewing best practices we expect from all EOLCCA Client Advocate Volunteers.   

Pictured above (r-l) are Stefanie Elkins, Judy Schnack, Karen Morin Green, Jill Schock, Lynne Zamarin, Judy Epstein, Lynne Calkins and Claudia Comins

We discussed the caring approach each volunteer will adopt in providing non-judgemental support to a terminally-ill client, and their loved ones, as they navigate the process of exploring all legal end of life options available to them in California, including medical aid in dying, allowed by the End of Life Option Act.  During that stage, the client and/or family may seek our experience and support as they interact with a new and unfamiliar array of healthcare providers, or to effectively communicate to family and their physicians the decisions they have made consistent with their personal values, beliefs, and desires.

We also reviewed the importance of Advance Care Planning (ACP), so that our volunteers can be of assistance to individuals who wish to learn more about preparing Advance Directives, well before they are facing a terminal or debilitating illness.  ACP is a vital resource that enables individuals to document now their future healthcare expectations, so that if the person becomes unable to communicate their healthcare wishes, their loved ones and healthcare providers are clearly informed.  ACP is, in fact, a useful tool for adults at all stages of life, young and not-so-young! Participation in advance care planning has been shown to reduce stress and anxiety for patients and their families, and lead to improvements in end of life care. 

Please browse our website for comprehensive information about all end of life options in California, Advance Care Planning, and to learn more about the resources, services and support EOLCCA provides at no charge.  

 

UCSF drops proposed partnership with Dignity Health!

We are delighted to let you know that patient choice has won again!  The University of California San Francisco has decided not to pursue a proposal to partner with Dignity Health in San Francisco.  Bravo UCSF!!

UCSF Chancellor Sam Hawgood and UCSF President & CEO Mark Laret sent out a letter this morning with their decision.  

 We heartily agree with the words of our Board member, Dr. Bob Brody, a physician at UCSF, “this is an amazing outcome”.  Yes it is!

Judy Neall Epstein,

Founding Director, President

End of Life Choices California
info@endoflifechoicesca.org

Movie Review: Paddleton (2019 Drama/Comedy)

A friend recommended I watch the new Netflix movie, Paddleton, just out in February.  I found it to be a worthy watch for someone interested in the intricacies of death and dying. Actors Ray Romano (Andy) and Mark Duplass (Michael), depict two middle-aged men who struggle with society and relationships in general, and even more so when one of them is diagnosed with a terminal illness and chooses to access California’s End of Life Option Act and medical aid in dying.

 

If you’re in a hurry, tired or sleepy, don’t watch this movie.  This is a film to relax into, as it is slow moving. It is an accurate portrayal of the struggle we experience when a loved one is diagnosed with a terminal illness.  The two men have an interesting and somewhat unusual friendship, and we see that in great detail as they grapple with Michael’s dying process and his desire to take medication to hasten his death.  I found it sweet and heart-warming at times, and sad at others.

However, there were some good questions that came out of it too, which I’d like to address:

SPOILER ALERT:  Reading further will ruin the film for you if you haven’t already seen it.

It appeared that Michael was able to easily obtain a prescription from his physician for medical aid in dying.  

This is generally NOT the experience in California, even though the End of Life Option Act has been in place for nearly three years.  Many physicians still will not prescribe, and many people wishing to use the law have great difficulty finding a physician who will. EOLCCA is dedicated to educating physicians about providing medical aid in dying to their patients and is committed to helping patients find physicians who will support them at this fragile time of their lives.

Why did Michael not have more support from health care providers, i.e. Hospice?  

I thought this was an important aspect of serious illness and dying that was missing from this film.  I realize it would have changed the film greatly, but still…. Hospice does wonderful work and provides excellent support both to people who are terminally ill and their loved ones. Hospice staff might have been present when Michael took the medication if the specific hospice allowed it; not all do, but many do allow their nurses or social workers to be there.  One could say that maybe it was a matter of affordability, as Michael did not appear to be particularly wealthy or might not have had good insurance. Those things would not have mattered in a real scenario because hospice care is covered by Medicaid or Medicare.

Why did Michael have to travel SIX HOURS to retrieve the medication?

Under the law, the medicine can be picked up by the patient, a designated individual, or mailed by delivery service (i.e., UPS/FedEx) if needed.  Again this worked well for plot development, but it is not accurate. It’s true that pharmacists, as well as physicians and medical systems, have the right to opt out under the law. So it is conceivable that there was no nearby pharmacy to Michael’s home that would fill the prescription. But it could have been delivered in another way.  

Why did Michael refuse the anti-anxiety pre-medication?

We don’t know what the writers were thinking, but Michael refused the anti-anxiety medication prescribed for him, which is a normal part of the aid in dying prescription protocol.  And he did end up experiencing a great deal of anxiety right before he died. This was his choice of course, and it is not for me, or anyone, to judge. However, it didn’t have to be that way.  The medical protocols that physicians follow in prescribing for medical aid in dying are very thoughtfully put together based on the opinions, experience and knowledge of many physicians and pharmacists in Oregon, Washington and California. They are also continually being improved. Every step is important, and our volunteers support individuals in following the prescription as written. It is the way it is for a reason.

Lastly, what I most loved about the film was the end.  

We all know dying is hard.  And it is difficult and painful to watch a loved one die, no matter the manner of death.  My experience in working with the dying in states where medical aid in dying is legal is that a death under those circumstances is almost always a beautiful death; a peaceful death.  Family members, friends and other loved ones are left with a sad heart, but a warm heart that they witnessed a peaceful passing from this world. I loved that this happened in the film, and that the two men were able to overcome their tremendous social discomfort and what looked like shyness, to share their love for each other.  It was a beautiful moment in the film and when it happens like that, it is always a beautiful moment in real life. I thought the film did a great job of depicting this important aspect of dying with medical support, at the time and the place of one’s choosing.