Death and Dying

Death is inevitable, no one escapes it. In fact, our greatest surprise will come at the moment of death, when everything we know comes to an end and the door to the unknown opens. We can never be fully ready for death, but with preparation, we can depart this life in good order, with peace of mind which has often been called the ‘Good Death’ by author Marilyn Webb. There is far more going on within us as we prepare to die than medicine might have us think.[1]

Still, no one should go willingly into that ‘cold night’ until they have lived the good life. No one should surrender to death until they have wrung out all they can from living. Ideally, when death finally takes us, it should come as a great surprise and not because we have surrendered. As long as we possess the will to live, we can enjoy a good life, right up to the moment of death, surrendering to a good death only because we have no choice.

Death comes to us all, but to those who live well, death comes to them on their own terms and on their own timing. There is strong evidence to prove that people who possess a strong will to live, live longer than people who don’t. Developing the ‘will to live’ and the ‘survivor mentality’ is something that can be both taught and learned. The ideal life is one that is lived with both quality and quantity. People who acquire the will to live, not only live a better life but a longer one as well.

This handbook is dedicated to helping people 1) develop a survivor mentality and healthy will to live and enjoy a higher quality of life as well as a longer life, and 2) achieve a good death at the end of life as part of a well-orchestrated process of dying.

1) nurture their ‘will to live’ as some people have a hidden will to die as evident by the way they life their life,

3) acknowledge their mortality so as to motivate them to adjust their life style to living their dream life… for if not now, then when,

4) prepare for death even during good health so that death is not something to be feared but to embrace when it comes,

5) make reasoned decisions regarding end-of-life choices and to control the process of dying,

7) die pain and stress free, peaceful and tranquil, and with dignity and nobility of spirit.

Death is a process, sometimes fast and sudden and sometime lengthy and predictable. Death has its stages, both physically, psychologically, and spiritually. Each aspect of death must be treated separately and collectively (because we are a whole being and each of our facets are connected) if one is to achieve a good death.

Three things determine our difficult and apprehension with dying: 1) lack of control over pain and suffering, 2) fear of the unknown, loss of everything we know, and unfinished business that plague us, and 3) lack of spiritual readiness to make the journey from this world to the next. If each of these apprehensions with dying can be handled properly, then a good death is achievable.

Since death is a process, a good death is also a process, and one that can be transcribed, codified, taught and learned. If one wants to experience a good death, then they need to do is follow a well-scripted process that has been proven to lead to a good death. The process of dying well is not inherent, because survival and struggle for life is inbreed into all living species. The will to live is not easily extinguished. Dying well can be guided and aided with lessons beforehand and during the process of dying.

Unique

While the process of death is similar, no death is exactly the same. Everyone’s will to live is different, we all have important unfinished business we need to complete, our bodies wear out at different rates. With so many individual differences in life, one should expect as many differences in death, yet in the end, people who have had near-death experiences report a common similarity at the moment of death. While life is as individual as our fingerprints, so is the process of dying. However, at the moment of death, there is evidence to suggest that we exit in the same way.

Closure

A good death has many characteristics. One of the most important is completion or finality of life. Most dying persons wants a good ending - a clean closure - especially closure in relationships that end on a positive note. “Part of dying well is to set things right will all people, with ourselves, and with our creator. Dying is the last chance to share your life with the people you care about, and to leave a legacy.”[2] If forgiveness has not been granted or asked for, then one’s deathbed is the chance of last resort. “Each person should decide how best to give his own life closure. The real work of dying is coming to terms with who you've become, what the world is about, your place in it, and the search for meaning.”[3]

Death as a Journey

“Death is a journey, the last journey we have to make in our lifetime. We should all strive to make it a good one. Ultimately, dying is nothing more than coming to the end of a journey…a life's journey of the soul to the point where it is capable of merging one's mind with that of God. Death is not an end but a transition, and we can learn to make that transition well.”[4] Death is not a journey that one makes willingly, but one that comes upon us all, and ideally after one’s body has exhausted its last resources. One’s healthy ‘will to live’ will ensure that we do everything we can to preserve our bodily resources during our lifetime. Dying should never come as a result of the exhaustion of our mental and spiritual resources. In fact, it is the robustness of our mental and spiritual resources that is partially responsible for the longevity of the body.

Attributes of a Good Death

Every death, whether it be good or bad, leaves a legacy and permanent and lasting memories to those left behind.[5] A good society that flourishes over time permits its members to live both a good life and a good death. “A good death pulls a family together and leaves a legacy of peace. We must find ways to bring about a good death in our society, mainly for ourselves and those we leave behind. A good death has a mixture of calmness, wisdom, confidence, humility, and good-natured humor. A good death leaves everyone who experiences it feeling uplifted, whole, complete, and without an undue sense of loss. To die naturally is to find a way to have a graceful death, a graceful exit for life, when the prognosis is terminal and further medical treatments are of questionable value. Like natural childbirth, a natural death can be a positive experience and a way of dealing with one of the great milestones of life. One should die the way they lived, within the continuing connectedness, relationships, and unconditional love.”[6]

“To die well, one must summon all their mental and spiritual strengths and prepare themselves for a new journey into the next world. Everyone must prepare themselves for the natural fear of death and trepidation of the unknown. One must be trained on how to die well…to experience a good death and to die in a manner that is consistent with the way they lived or better yet, the way in which they dreamed of living. Death was never meant to be a sad ending, but a holy event that can be witnessed for the betterment of all concerned.”[7]

A good death will depend on medical treatment and terminal care aimed at easing the suffering at the end of life and not on the cure of untreatable diseases. A good death will depend on attending to and conditioning the dying person’s mental and spiritual condition so that they are peak functioning during the period of dying.

The dreaded conditions of pain and suffering during dying must be avoided. A good death requires assistance from trained professionals who know the business of death and dying. “No one want to have their dying become a burden on others, including a financial burden. It is not death that people fear so much as they fear a bad death…a torturously prolonged dying, with poor medical management for pain and suffering, a loss of bodily control, and the indignities of helplessness. What matters the most at the end of life is pain control, dignity while trapped within a decaying bodily and functioning, help for the psychological and spiritual anxiety of death itself. Real work is required to achieve a good death.”[8] A person's greatest performance as a human being is called for during the end of their life. Everyone wants to come to end their life at the top of their game, giving the performance of a lifetime.

The concept of a good death does not simply imply proper medical treatment during the process of dying. The proper focus of medical treatment, when nothing more can be reasonably done to cure or reverse the death spiral, is to make the end as free of pain and suffering as possible, so that the patience can experience the highest quality of life possible even while dying. Ultimately, a medical decision must be reached regarding the withholding of technological treatments that serves only to prolong the act of dying. The medical decisions at the end of life are focused on deliberately creating a medical environment that allows for a peaceful death. A good death requires support from the medical community.

In summary, a good death by the dying has these attributes, all of which are achievable[9]: 1) open, ongoing communication between the dying person and care givers, 2) control over decisions regarding their care, 3) free of pain, suffering, and symptom control, 4) Limits on excessive treatment, 5) preserving the quality of life, 6) emotional and psychological support, 7) financial support for the cost of dying, 8) family support, 9) spiritual support, 10) medical personnel and care givers are supportive and do not abandon the dying person.

At the end of life, what matters most to the dying are unseen, nonmaterial aspects of life. It is the intangibles that become of paramount important…the bonding, uniting, caring, and loving between those who have been important to the patient during their life. Love and acceptance of self for having lived a good life, best prepares one for the end of life and transcendence via death to the next. “There is but one freedom, to put oneself right with death, after that, all is possible.”[10]

Some people have an unconscious wish to die. They have unconsciously measured the value of their current and projected life and judged it to be inferior to that of death. The people with the will to live are the exact opposite. There is progressive and continuous divide between the extremes of a ‘will to die’ and a ‘will to live’. The closer one’s personality lies towards the negative end of the scale, the will to die, the closer they are to a terminal illness that will ultimately carry them to the death they seek. The closer one is to the positive end of the scale, possessing a will to live, the more resistant they are to disease and succumbing to disease and illness.

Everyone, especially those who are living with serious illness are constantly balancing the rewards of life versus the cost of living. Many people mistakenly live their life by a life style that deliberates cuts it short.[11] It is almost as if these people have an unconscious death wish. What is interesting is that even though these people are living a live they deem to be devoid of value, they take no concrete actions to change it. These people obviously feel trapped and helpless in their circumstances. They are living without the hope of a better life.

Patients with a death wish need to be treated with a plan that restores their will to live. One cancer patient remarked to her physician, "I have an empty space within me and the cancer grew to fill it." Everyone needs something to fill the vaguely understood ‘void’ within them. People don’t have to get sick to get out of their predicaments. Happy people generally don't get sick. Research has shown that those people who were extremely satisfied with their lives had one-tenth the rate of serious illness and death suffered by their thoroughly dissatisfied peers. Family, relationships, and job satisfaction are of key important to health.[12]

Even though they are ill, everyone can be an exceptional patient if they are deeply imbued with the will to live. People who react to a diagnosis with a fighting spirit tend to survive longer than those who don't. The best time to begin building the survival mindset is before getting sick. Whatever their measure of vitality and life force within them, most people don't make use full use of it. Death is seldom the issue for those who are ill. The real issues are usually the will to get will and continue living the life they have or how to change their life so as to life it to its fullest. Death can be considered a failure only if the patient did not willingly heal themselves and struggles for their own wellness. Not choosing to take on the challenges of life is the cause of failure to treat illness and ensuing death.[13]

To live long and prosper in happiness, one must build the will to live within them. Not only does the will to life offer a better and more prosperous life, but also when you come to the end of the journey, you will experience a good death. “As long as you are alive, you can participate in life by loving, laughing, and living. Live your life in such a manner so that when you die, the world cries and you rejoice.”[14]

The medical profession unduly focuses its attention to the treatment of the disease and illness of the body, and ignores almost completely the potential contribution of the mind and spirit to healing. Medical school teaches all about disease but nothing about what the disease means to the person who has it.[15]

The ‘will to live’ is inimically tied to having found a reason to live. A sense of meaning and purpose gives people a reason to keep on living and without meaning, people tend to give up and die sooner. No matter how much pain and suffering one is burdened with, it is better than death so long as one can find meaning in their living. There will be death soon enough, so there will not always be life in which to complete one’s purpose. Every moment, every movement of this life towards one’s purpose is better than having no life at all.[16]

There is no reason for anyone to lose this sense of purpose even during the period of dying. A purpose gives life nobility and supports the ability to live a high quality life. “It's the effort of working towards nobility and virtue that bring its highest rewards.”[17]

“When meaning comes entirely from people/things outside them self as self-validation and when that connection is broken, cancer is often the result. Cancer is a symptom that something having gone wrong in the patient's life, a warning to take another road.[18]

Each person must find how to make their own life interesting enough to enjoy the life they have. The biggest obstacle people have in living a meaningful life is to get over the idea that work is the only meaningful purpose in life. Each of our life roles can be a blessing if we come to it with a purpose in mind.

The unhappiest people are those who haven’t found their purpose. They play their roles without a reason for doing so. Instead of gaining satisfaction from the roles they choose, they are forever trying to control the roles of others and the pageant they play in. “All unhappiness arises from attempts to control events (expectations) and other people, over which one has no power.”[19] Once one finds success by playing their own roles well, which are the only ones they can control, they can back off trying to manipulate others and events over which they have only tenuous control. The more people can get what they want on their own, the less unhappiness they will experience when events and people don’t conform to their expectations.

A person whose life is devoid of meaning likely has many unmet needs that they are ignoring at the peril of their health. However, once a person's unmet needs are acknowledged, they can move on to find ways to satisfy them that doesn't include the disease or illness they may have unconsciously taken up to fill the void. It's important to discover what needs any disease is meeting by the symptoms it produces. Then, the patient can set goals that meet those needs in place of the illness.[20]

Few physicians taken into consideration either the ‘will to live’ or its converse, the ‘will to die’ instinct, in their patients. They just simply treat the bodily symptoms. Only the exceptionally astute physician assesses and treats the patient’s lack of will to defeat the illness or disease, which is perhaps the most power tool in the arsenal. While it is not up to the physician to evaluate the worth of continued life for another person, they do owe the patient and effort to help them find and assess their sense of value for living.

The physician has a powerful effect on a patient’s will to live, just because they are in a position of authority. By getting the patient to react optimistically to a diagnosis and begin treatment with a fighting spirit, the physician endows the patient with a higher survival rate.

People who have a fighting spirit and a will to live respond positively to the question of whether they want to live to be a hundred.[21] Exceptional patients who receive the miracle cure and survive are a minority, because healing is a combined act of medical technique on the outside and the patient’s own will power on the inside.

To instill within a patient the will to live, the care giver must change from the patients whole outlook on life, from the inside out, by becoming building a relationship that is loving and accepting. Before the doctor can deal with the illness, he must first help the patient find a reason for living. The doctor must test the patient's will to live and then try to strengthen it. “Not every illness can be overcome, but many people allow their illness to disfigure their lives more than it should.”[22]

There is always a margin within which life can be lived with meaning and even with a certain measure of joy, despite the illness.

The physician must ask the patient, “Do you love yourself enough to take care of your body and mind? Do you seek activities that give you joy and satisfaction?” Sometimes, the cause of a ‘ distress and onset of illness lies in very recent events that have turned the patient’s life upside down and greatly diminishing their will to live. It doesn’t hurt to ask, “What happened to you in the year or two before your illness? Why do you need this illness?”

Show me a patient who enjoys living and I'll show you someone who is going to live longer. Those who survive their illness are willing to do whatever is necessary to survive. For those who are ill and suffer, nothing is going to help them if they don't want to help themselves. What a physician is listening to hear is a positive, optimistic response when asked about their recovery. What the doctor wants to hear, when a person responds to the question of whether they are ready to die, is the words, "Considering the alternative, no I’m not."

No physician or treatment can make you well by itself without the will to heal. Thus, the physician may begin a course of treatment, but if the doctor does not inspire the will to live in the patient, there will be no healing as a result. No one will be cured or healed who doesn’t want to continue with their life they have. This is why lifestyle changes are crucial to a successful cure. Changes for the better gives people something to live for…a will to live.

Chapter 3 - The Power of Hope and Optimism

The power of faith and hope is so strong and ubiquitous as a healing technique that it even has a medical definition, the Placebo Effect. If someone deeply believes in a treatment, then it tends to have a positive effect on the malady it is treating. It is not so much the treatment producing the healing as the belief by the patient that is causing the healing effect. The mind has the power to create what seems like miracles of healing in the body. Unfortunately, the opposite is also true. If someone strongly believes that a treatment will not be effective, it likely will not, despite its curative, medical powers. The caregiver of the ill must use the Placebo Effect as one their tricks of the trade when rendering care.

Our reality is contained in our beliefs. Some of our beliefs are conscious, but the ones that cause the most confusion and impact our wellness the most are those that lie hidden within our subconscious. People often talk a good talk about getting well, but what counts most is what they believe deep within their subconsciousness. “What we say is often a cover up, because we're all trained in language and social customs to avoid exposing our vulnerable parts and to conceal subjects that would disturb us if they were revealed.”[23]

“Beliefs are a matter of faith and not logic. Beliefs affect the power of treatment. Negative expectations often are the cause of more serious side effects such as nausea following chemotherapy and hair loss as a result of radiation.”[24] We need to put our beliefs to work to help in healing with the power of suggestion, most notably the suggestions of the physician.

One belief that holds us in check most of our life is the belief that one should not take chances and rock the boat. Many of our most powerful and troubling beliefs are formed in childhood before we have developed rational ways of blocking them. Children love and trust their parents and are willing to believe anything that ensures the continuity of a patents love and acceptance. “Unfortunately, too many children get everything they want and nothing they need. What children need most to develop into mentally healthy adults is unconditional love and acceptance. Childhood conditioning is a strong factor in the ‘will to live’ and our generic concept of self-esteem or worthiness to live. As parents, we are, in a sense, our children's first hypnotists and can give them positive post-hypnotic suggestions and inoculations to ward off failure and boost survivor's mentality as they grow into adults. Unfortunately, a hopeless, helpless parent will produce a hopeless, helpless child. If a weak self-concept is conditioned during childhood, the adult may become crippled for life. Letting go of the fear of loss of love is the sticking point for many people if they see every social interaction as a request for or a giving of love.”[25]

People will not stray far from their comfort zone if they are fearful of their ability to handle life and meet their most important needs for love. If they believe that love is conditional upon what they do, their behavior becomes limited to these beliefs. By staying tucked safely into one’s comfort zone, they never get to experience the extremes of life from which great joy is derived.

When good things happen to us, we should not dismiss them as pure luck or coincidence. One might consider the possibility that there might be some intelligent design and intentional interventions behind our lucky breaks. We need to respond with more follow-up than dismissal, something broader than just accepting the coincidence as a gift. A coincidence just might be God’s way to revealing himself to us. It takes faith to consider the possibility of a greater force at work. No matter what good thing happens against unbeatable odds, one could always claim it to be a coincidence. In dismissing the miraculous to coincidence, one would never gain the sense of grace and peace of mind that would flow from believing something more spiritually significant going on.[26]

“Grief, despair, and discouragement have a negative effect on the outcome of an illness just as faith, confidence, and peace of mind have a positive effect on healing. Depression is often the cause of many illnesses and the onset of disease. One simply is willing themselves to death. The mind and the body connection ensures that the body will eventually catch the illness resident in the mind.

The most important precondition for recovery is that the patient picks a treatment that they can believe in and proceed with a positive attitude. If a patient doesn’t have faith in the treatment, no cure is possible and healing will not occur. The mind’s adverse effect on healing is the Placebo Effect in reverse. What the patient believes, more often then not, becomes the medical outcome they receive no matter what treatment option is selected. The four keys to ‘faith’ healing are faith in oneself as a survivor, their physician, the treatment plan, and spiritual beliefs.[27] The physician can stimulate all four of the centers of faith. Thus, the patient’s hope, trust, and camaraderie with their doctor is critical for a successful treatment outcome. Also, faith in God or transcendence doesn’t hurt either and in many reported cases, can make a considerable difference in the efficacy of treatment.

Hope and love are complementary and effective therapies to the treatment of disease. Doctors should never deny their patients hope. Doctors must encourage the patient the option to participate in their recovery from any type of disease rather than to presume that some diseases or conditions are untreatable, thus denying the patient hope. A doctor that harnesses within a patient hope, survival instinct, will to live, and intense self-concern, dramatically improves the patients chance of recovery.[28]

A doctor should not prescribe a treatment plan for a patient until he has first instilled with in him the hope, survival instincts, and the will to live. Otherwise the treatment and the resources expended may be squandered. People get better only if the physician gives them hope and puts them in control of their own lives.

Giving a patient hope simply means that their recovery doesn't have to follow statistics and that they can be the exception, a miracle cure that others before them have experienced. All hope is real in a patient's mind.[29] Positive expectations of recovery have a strong power to influence recovery. A patient’s refusal to hope is nothing more than a decision to die. Hope is the one factor that cost little but without it, little can be accomplished.[30] With hope, one can live to accomplish many things during and after recovery.

A patient's hope and trust/confidence in their physician leads to a letting go of doubts and counteracts stress and anxiety. Hope is the key to getting well. A good physician will actively build the conviction that the patient is destined to get well, no matter what the odds or how dire the progression of the disease. Acceptance of the possibility of death need not take away the hopes the patients for a cure and continued living. The truth can always be delivered with hope and optimism, since no one can be certain of the future. The physician should counsel the patient that no matter how grave the situation, there is no incurable disease or condition. When a doctor can instill some measure of hope, the healing process sometimes starts even before treatment begins.[31]

The miracle cure comes from the hope and the changes that the patient makes in their life while they are undergoing the new treatment. People heal by doing something they believe in, something that gives them hope. Hope is an active effort in that it requires seeing the outcome you want as possible and then working actively to achieve it.

When one is in love with life, their life, and the people in it, they are very resistant to bodily infirmities. “When we commit ourselves to egoless, unconditional love, true healing begins. The doctor cannot permit a patient to trade their illness to gain conditional love, because it means the patient is willing to die to get the love and acceptance they covet.”[32] The patient must stop trying to change their significant others through manipulation, such as susceptibility to illness and disease. Instead, they need to devote themselves to just loving others and accepting the people they love for who they are and where they are in their life cycle. The ability to love oneself, combined with the ability to love life, fully accepting that it won't last forever, enables one to improve the quality of their life. Love's blindness is therapeutic, because it allows one to function without storing the images of life's difficulties within themself.”[33]

The physician can elicit greater nurturing by the patient towards how they treat their body. When the physicians observes detrimental conditions present in a patient’s life they should not hesitate to ask, “Do you love yourself enough to get well?” A question such as this one often gets the patients rapt attention. “Don't tell the patient to stop smoking, but instead, tell them to love themselves more, and then, they will stop smoking on their own accord.”[34]

“I believe that all illness is caused by a lack of love or a love which is only conditional and therefore highly disputable and deniable. Thus, all healing is related to the ability to give and accept unconditional love. Unconditional love is the most powerful known stimulant of the immune system.”[35] Love not only heals, but love leads to a higher quality of life. “The idea is to love, because it feels right and good, and not because it will help us live forever. Love is the end itself, not the means to something else. Love makes life worth living, no matter how long life lasts.”[36]

Love is incredibly powerful in the midst of conflict. It is face-to-face love that carries the most powerful emotional power. When you love, you receive love at the same time. Thus, should you ever find yourself in circumstance of lacking love, you need only give love to others in order to receive it. There is no difficulty that enough love cannot conquer.

Hope and optimism are very nearly one and the same concept. Hope is faith in the outcome of a future course of action, whereas optimism is the ability to see the good right here and now. The optimist deliberate wears ‘rose-colored glasses’ and possesses a bias for looking for and finding the good even when it is not obviously present. Optimism is a belief that there is good in every situation, and one only has to take the trouble to find it. By looking for what could be the good within their circumstances, they usually find it. “A positive, optimistic attitude and atmosphere is conducing to cure and healing. Never deliberately think negative thoughts about your body even for a positive goal. We prepare our future by what we think and do each day.

Some people believe that our future is already preordained and uncontrollable. All we can do is live it in the moment. “Yesterday is gone, tomorrow isn't here yet, so what is there to worry about?”[37] Our only choice is how to live each day, as unexpected as it might be. However, even if the future is being prepared for us by the thoughts and actions of everyone that has ever lived before us and all who are currently living at the moment, we don’t necessarily know that future and we still have to make choices and respond. We still must manage ourselves now so that not only will now be worth living but we are paving the way toward a desirable future.

Since our present actions and thoughts are creating our future, the prospects for our future can be intuitively guessed. “The future is unconsciously prepared for us long in advance, and therefore can be guessed by clairvoyants.”[38] The ability to guess the future allows us to integrate the actions we take today into what will eventually become our future. Predicting a desirable future for oneself, and then acting as if this prediction was coming true, is best way to ensure oneself of a quality life.

People who survive adversity do so because they have a survivors mentality. He survives who thinks he will. The survival mentality includes a combination of the ‘will to live’ and a belief that not only shall they survive but they are predestined to. It is a felt ‘call to greatness’ that compels the survivor to endure against great odds to claim their rightful place in history.

A survivor is one who wills themself to survive. Survival is based on a mental attitude and sheer will power; an unshakable belief in oneself to overcome whatever adverse events has overtaken them. Survival is 80% half mental, as Yogi Berra might have said. “People with an inner locus of control do not fear the future or external events. They know that happiness is an inside job.”[39] It also requires an active involvement in one’s treatment and a strong will to survive and to live.

Healing requires energy to mobilize and galvanize the body to heal itself, but only positive energy heals. Positive energy comes from our positive emotions. “When one chooses to love, forgive, accept, and find peace of mind, healing energy is released in our bodies.”[40] This healing energy is linked to hope, optimism, and the will to live. This healing energy is released not only by positive thought but by meditation, imagery, relaxation, affirmations and auto-suggestions, hypnosis, body movement, and tapping one’s energy meridians (see Emotional Freedom Technique).

Patients who respond least well to treatment are those who are dependent on others for motivation and esteem, who used psychological defenses to deny their conditions, and who visualized their bodies as having little power to fight their disease.[41] The more control the patient believes they have over their own death and dying, the more control they will exercise. To heal, the patient must be conditioned to believe that the outcome is up them.

Patients must be made to feel that they are in control of their own recovery and empowered to do with the aid of the physician, care givers, and psychological counseling (tapes or group therapy sessions). People have the power to control their own thoughts, emotions, and actions if they focus their natural energies in a positive direction. Our emotions don't have to ‘happen to us’. Most often, we unknowingly choose them, and often times, the wrong emotions emerge. Our emotions can serve us, or they can hurt us. Some emotions are just neutral. “People who give vent to their strong emotions survive adversity better than those who are emotionally constricted.”[42]

One tip for controlling an upsetting or negative emotion, as it arises deep within us and if we are alert enough to catch ourselves, is to quickly counter with a positive thought or simply to adopt a facial expression of a contrary emotion. Even a forced smile can temper anger if we intercept it before it gets out of control. Unfortunately, once a negative begins to rage, our subconscious has taken control, and it is not easy to wrestle it back. So, when you feel the blues coming on, start smiling and acting happy, even if you’re not and you don’t feel the urge, do it anyway. We can control our bodily functions and actions better than we can control our emotions in the short term. Our overt bodily actions can override and counter an emotion but we must do so quickly.

Some patients need to be taught how take control of their illness. They must be told to stop acting as if they are helpless. One way for the patient to take control of their illness is to make life style changes that are contributing to the illness and when reversed will support health when it is recovered. As long as one is alive, one has control over their destiny. Observations show that patients who were offered an active role in their treatment needed less medication and have fewer complications. Shared responsibility between physician and patient increases cooperation and reduces the resentments that often lead to malpractice suits. In hospitals, patients who get up and walk as soon as possible are the ones who recover most quickly from surgery. Exercise offers immense benefits including 1) stimulates the immune system and enables us to cope with stress, 2 gives us a greater sense of self-esteem and control over our lives, and 3) offers a chance for meditate, because we don't have to think about what we are doing.”[43]

Research has shown that dying patients have an amazing amount of control over their dying. The terminally ill don't have to die until they are ready. When patients whose bodies are tired and sore are at peace with themselves and their loved ones, they can choose death as their next treatment. Death need no longer be considered an out-of-control event, a random failure of the body but a natural option under the control of the patient.[44]

Some people heal themselves no matter what external medical aids they choose, as long as they have hope and control over their treatment. If one thinks healing thoughts, healing is promoted.

Healing comes from may sources including life style changes, acceptance of responsibility, spiritual awareness, sharing and loving, meditation, guided imagery, affirmations, changes in beliefs and hopes. For example, affirmations of positive beliefs aid both the body and the soul. Neither the patient nor the physician should forget, It is the body that heals, not the therapy. To heal, the patient must flood their mind with positive images and visualizations of survival and conquest over the disease afflicting them. Healing is hard work as is any change one must make in one's life.[45]

More attention needs to be given by the medical profession to mental conditioning as opposed to treating symptoms and medicating. For example, a hospital environment that is focused on fostering conditions for self-healing can be expected to have a higher cure rate. “The hospital environment needs to be converted into a healing environment.”[46]

A healing environment can be nurtured with the presence of optimism, hope, humor, beauty, uplifting music, and serene surroundings. “A sense of humor and the presence of laughter is an enormous asset in effecting a cure. Humor's most important psychological function is to jolt us out of our habitual frame of mind and promote new perspectives or points of view.”[47] Life requires a good sense of humor and so does death.[48]

The will to die can be as powerful as the will to live. To overcome one or to stimulate the other, you must summon enormous positive energies to restore or bolster the survival instinct. “Although the mind in incredibly powerful, it takes something equally powerful to turn it on. One should mobilize everything they can possibly believe in to aid in the power of healing. The thing that cures our psychological problems must be at least as convincing and powerful as the cause of the problem.”[49]

One of the most power of all energies sources is self love…an unqualified self-regard, or self-esteem that one is both capable and deserving of a quality life. “An unreserved, positive self-adoration remains the essence of health, the most important asset a patient must gain to become exceptional. Self-esteem and self-love are not wrong but make living a joy instead of a chore.”[50]

Interestingly, the people who are most susceptible to illness and disease are those with the lowest self-esteem. When people believe they are not good enough as they are but only by what they do, have, or connect to, this is evidence of poor self-esteem. If a person has lived their life believing they are not good enough to secure and enjoy their most profound sources of pleasures, then due to the direct linkage between mind and body, they unknowingly are putting their health at risk as the body strives to conform to the attitudes of the mind. Poor health eventually becomes a certainty. “Certain diseases seem to stem from a lifelong pattern of self-denial and a sense of not being good enough. One doctor found that 80% of his patients felt unwanted or treated differently as children, thus developing as a result, deep feeling of unworthiness. Some patients unconsciously believe that only by illness or dying can they get the love they crave. Patients with low self-esteem often develop cancer in one specific area that has a psychologically significant importance to them - the target organ.”[51]

Due to the psychological contribution to health and illness, a physician cannot just treat a patient’s disease while ignoring the patient’s lack of will to live. What many patients need more than anything is a positive stoking of their self-esteem. A success treatment of a person's self-esteem boosts their will to live but also their immunity, stamina, and self-healing abilities.

Low self-esteem is not easily treated. Sometimes it is far easier to treat the illness. But an untreated self-esteem will eventually manifest a new illness because it is often the root cause many illnesses. To permanently boost one’s sense of self-worth, the person must grow the ability to love unconditionally (a form of egoless love for life and everything in it) and achieve inner peace, an acceptance of what is…including what is not preferred. Certainty, building these conditions is not easily modified in the short term and will require the assistance of a trained therapist. For this reason, the parallel of mental health therapists during the medical treatment of any disease is strongly recommended. Changing a patient’s negative view of himself or herself is not something that happens quickly, but an on-going and parallel effort can be part of the miracle cure.

If a patient’s own survival instinct cannot be activated and mobilized, and they don’t have the will to get well, then they won’t. Self-esteem is a personal characteristic that is build over a lifetime and affects one’s expectations of how life operates. If these expectations cannot be converted to hope and optimism, the treatment by itself will have limited effectiveness. When a patients thinks that they are worthy of getting well, they will work harder to make sure the medical treatment works by applying complementary activities such as meditation, imagery, relaxation, affirmations, journal writing, and listening to one’s inner survival voice.

”Less than 20% of the population has an inner locus of control and who are guided by their own standards. Those with healthy self-esteems know that they will never meet anything they can't handle. Medical treatments, drugs and surgery can only buy time while the patient works to change their lives, and as a result, heals themselves.”[52]

The fundamental problem with most sick people is an inability to love themselves - due to a lack of self-esteem - because they don’t consider themselves to be lovable, again. At some crucial point in their childhood, they were unloved by their parents in a way that they craved or their adverse relations with their parents established a negative way of coping with stress. The more the patient can be guided towards productive ways to contribute to the world in a self-worth enhancing way, they can be guided towards a sense of meaning in their life and hence a reason to get well. When a person chooses to give something back to the world, as a side product, they develop an inner sense of worth that helps them achieve personal goals, including overcoming their illness, that improves their own quality of life.

As already mentioned, there is a strong relationship between the patient’s mental attitude and their chances of surviving their illness. Medical researchers have observed that people divide themselves into two camps: survivors and those who seem to give up and those who never rise to fight their afflictions and subsequently succumb to its ravages. By adopt the attitude that “I will beat this disease”, and after doing so, returning to a more satisfying life that they create for themself, the former patient tends to live in relatively good health. “Hippocrates said he would rather know what sort of person has a disease than what sort of disease a person has. Patients with the will to survive either have a strong reason to live or a willingness to dramatically alter their live style so that they increase their likelihood of doing so. The will to live greatly increases one’s chances for a cure. Survivors do not rely on doctors to take the initiative but rather use them as members of a team, demanding the utmost in technique, resourcefulness, concern, and open mindedness. The exceptional patients refuse to be a helpless victim. They educate themselves and take control over their recovery, making whatever life style changes are necessary to effect a miracle cure.”[53]

“A survivor believes that life is a serious of obstacles, and they believe that they have the ability to overcome them. Survivors have a hierarchy of needs like everyone else, but unlike everyone else, they pursue all of them. Survivors possess synergy and closure of life’s continuing source of problems. The need for synergy is the need to have things work out for oneself and others. Survivors save their resources for the really important things in life. When things are going well, they let well enough alone. Survivors have strong egos and a sense of their own adequacy. They have a high degree of self-esteem and self-love. They retain control over their lives, have a strong sense of reality, and are self-reliant. Survivors interpret problems as redirection, not failures. Survival is not necessarily limited to age, but instead, survival is an innate or learned ‘will to live’ no matter how dire the situation. People become survivors when they realize that their deepest need is for the love of life and to be at peace with others and themselves. The motivation for survival becomes spiritual or selfless, not selfish.”[54]

To survive any disease, you must believe that you are the exception to the statistical norm and are different than the typical patient. You must believe that If anyone is capable of surviving, it is you. A survivor mentality helps one get better, faster, and with fewer side effects. What some doctors call a ‘problem’ patient tends to be the one who survives and heals rapidly.[55] What the world needs is more problem patients who seem to become the cause of their own healing.

Chapter 5 - The Power of Change

A person with a will to die can be converted to a person with a will to live by changing their beliefs, self-esteem, and life choices. One cannot change for the better by staying the same. To change for the better, one must change not only their beliefs regarding their self-worth, but also how they live their life within the context of their world view.

People deny the need for change and resist all logic for leaving their comfort zones, even when change is right, proper and essential to good mental and physical health. Only when the pain of their present circumstances becomes overwhelming, unbearable, and irresistible, do some people let go and go with the flow. Disease and illness is often nature’s way of telling people that their current way of life needs to change if they want to life fully. If the will to live is weak, the will to die is stirred and eventually dominates the direction of one’s illness. To heal, the patient must become open to the changes needed to bring about health and wellness. “One of the roles of the medical doctor is to help the patient develop into a new person so as to mobilize their inner power of self-healing.”[56]

Before one changes what they do, their lifestyle, they must first change their beliefs. What drives all other aspects of a person’s life is what they believe about themselves, their worthiness, and their self-love…in other words, their inner programming. This shift in the patient’s mental state is not solely the physician’s job. Working in concert with mental health therapists, the attitude of the patient’s doctor can be instrumental in shifting the patient’s attitude and beliefs in the right direction. One’s beliefs can have a profound impact on not only their quality of life but its longevity as well. Thus, the most important change that anyone can make for the better is the eradication of negative, irrational beliefs and to substitute them for positive, live-enhancing beliefs. The notion of a will to live is nothing but a set of positive beliefs about the direction and course of one’s life. Likewise, the notion of a will to die is a resignation that life is not worth living or that the person’s is not worthy of the life they want.

The most important beliefs that any person can have is a belief in a positive life force at work within themselves (they are capable of meeting their own needs) and an inherent right to live a good life. This network of core beliefs is often called self-esteem, wherein one thinks of themself as both capable of achieving a good life and worthy of the rewards that their competency and hard work brings them. One’s set of core beliefs can be influenced in the positive direction by deliberately concentrating on the “light of goodness” through meditation, prayer, and other spiritual practices. Just the simple, positive action of setting and achieving goals reinforces feelings of competence and self-worth.[57] However, to affect the best outcomes, one should not attempt to change themselves, but rather, get help from competent professions or therapists who trained to effect personal change. One must lead the effort to change by becoming a cooperative patient.

Most people must suffer, and sometimes a great deal, before they are ready to transform themselves. It is only through pain and suffering than people become motivated to change. People can change at any time, as soon as they decide that change is the right thing to do. However, they will need assistance in deciding the direction of change and overcoming the difficult of modifying their core beliefs that are needed to support the change. The earlier change occurs in the course of any illness or disease, the greater the chances of recovery. If a person gets on a positive-life-force path early in life, they become practically invulnerable to disease and misfortune.[58] Emotional maturity and evolving growth towards greater self-acceptance and fulfillment of one’s potential helps keep the immune system strong.[59]

The medical profession is largely stuck on treating the illness the presents itself. Behind most illnesses is a mental condition that is often the root cause. If the root cause is not treated, then either the treatment will fail or if it succeeds, it is only temporary. The medial profession needs to take a more creative approach to both treatment and prevention. No disease should ever be treated independently from its potential mental causes. The patient’s subconsciously held beliefs need to be explored, challenged, and changed.

Changing a patient’s subconscious beliefs can take many forms, and creativity in a therapy treatment that best fits the patient can take many forms. Unfortunately, the patient is too close to their possibilities and can’t see it for him or herself. So few people actually exercise their alternative treatment options that a multitude of opportunities are missed for those who most need them. No good effect is gained without effort, and it's the mental effort that most holds people back from changing for the better.[60]

When people get sick, it is the restoration of one’s ‘life force’ or will to live that is largely responsible for healing themselves. Helping patients achieve an inner peace of mind is good not only for living a quality life but health, immunity, and healing as well. Thus, getting well is not the only goal of medicine and treatment.

People who are the most judgmental of others are the one’s with the lowest self-esteem. By judging and denigrating others, the person feels a temporary boost in their own self-esteem. People with high self-esteems seldom feel the need to judge others for they do not have the need to judge themself or find ways to feel superior.

A person with a healthy self-esteem are willing to learn and asks themselves what they can learn from every experience. Even in the presence of difficult times and problems, they continually ask themself what lessons they are here to learn. Most already know the right answer. The ultimate lesson one learns from any experience - the ultimate solution to any of life’s difficulties and the source of all great joys - is in finding ways to distribute and radiate their love more fully to the world.[61]

We all have a purpose to fulfill while we occupy space in this existence. In some way, we all have the same purpose, which to use our innate ability to love to bring enrichment and joy to other and ourselves. This is our purpose from birth until the end. Everyone finds different ways to fulfill this common purpose. We all get the right to choose our own way for achieving the same purpose of spreading love, because each of us has a different calling, a different set of talents and gifts to offer the world. People with the will to die, just haven’t found their calling yet. It is never too late to find one’s calling. “Here's a test to find whether your mission on Earth is finished: If you're alive, it isn't.”[62]

The noblest human opportunities are the ones that allow us to live our calling and spread our love in the best ways we have discovered. “Life is nothing if it is not the opportunity for something.[63] People who see opportunity, related to their calling, are the one who are actively living their purpose. The best opportunities are often hidden in the most severe circumstances and intractable problems. Even in sickness, there is opportunity. “The ability to see something good in adversity is perhaps the central trait needed by patients. To live is to suffer, to survive is to find meaning in the suffering and the life that comes after it.”[64] While life can never be perfect, the life we get is good enough. “We are not born perfect. I'm not OK and you're not OK but that's OK.”[65]

People need to visualize themselves as a fluid spirituality that flows effortlessly in the search for endless ways to spread their love for which there is no end…love is never exhausted. Even dying patients need to see themselves as a life force that is moving ceaseless towards a destiny that they are not permitted to know. Never knowing when the end might come, the dying need to keep living and loving, as their mission is not complete until life is taken from them and they are granted eternal rest. Patients need to be counseled to view themselves as a dynamic actor within an ever-changing life drama, who is only bounded by the inevitability of death but not ruled by it. As long as they are alive, as actors on the stage of life, they are free to drop one role and pick of another so long as it advances their purpose. New opportunities call forth the need for new roles. Growth comes from shedding one role that fails to fit the current situation and garnishing another. Life needs to be ruled by a goodness of fit between our drama and our roles.

You say you don’t know what role you should be playing, then you need to listen harder. Whatever role allows you to play your part in the pageant of life, your purpose, is the role you should be playing. “If you take the time to listen to your inner voice, you will learn your purpose. Find your life and live it. Live inventively.”[66] Not only does playing a role well make you feel good, it's also a dis-inhibitor that opens the door to creativity and to a wider enjoyment of life.

As one moves within their life cycle, from present to the future, there will be moments and seasons when genuine sacrifice of the most valued thing is essential for future growth.[67] Growth demands sacrifice of one thing for another…the giving up of a favorite but obsolete role will be necessary. While we cannot foresee the future, we can know when it is here. “Creative and synergistic functioning calls for the ability to see early clues about future developments and take appropriate actions now, while keeping a positive outlook and confidence even in adversity, and cooperative nonconformity. Even seemingly coincidences are signs that the future is here and we need to heed what the opportunity is offering. Some people have a better presence of mind to heed an emerging future while it is still quite young and to adapt the appropriate role seamlessly. Some people have a talent for capitalizing on serendipity, which is the ability to convert seeming accidents or misfortunes into something useful and the feeling of getting smarter and enjoying life more as you age.[68]

One way to boost a synergistic perspective for integrating one’s life with the oncoming future is by working within a support group and regular meditation in which you visualize yourself as you want to become.[69] Collectively, a compatible group can harness the power of synergy and see more than the sum of each individual. The group can see and share what the individual cannot see. If you want to see your future, form a growth group with people you know and trust, and then participate and listen. You can learn a lot just from listening. .

Chapter 6 - Mind and Body

The mind and body are not entirely separate organisms. The mind and the body operate as a team, an integrated system. To gain mastery over mental and physical health, the mind and the body need to be treated collectively.[70] Within a system, all the parts must work together as a cohesive whole for optimum results. Any malfunction of a single part will affect the entire system…the functioning and well being of one part effects the other.

Everyone knows that any ailment of the body greatly affects our zest for life and ability of our mind to focus on other matters. Likewise, the mind has a significant impact upon the body. If we don’t think we can, our body won’t. Any psychological distresses tend to find its way to an equivalent bodily feeling. Some mental ailments (will to die) tend to be reflected and manifested in the body with disease and afflictions. On the other hand, a healthy mind (will to live) tends to promote a healthy body. People with healthy minds have greater resistance to disease and illness, and if and when their body gets sick, their survival instincts quickly mobilize the body’s resources for faster healing.

Everything we do and think, affects our health. The mind can dramatically effect the body.[71] How we act, what we think, eat and feel are all related to our health. How our body feels tells us something about what the mind is thinking and acting. Science and medicine is just beginning to understand the powerful connections between the two. There is much more to learn.

“Pay attention to the messages your body is sending you. If you ignore your body and its messages, at some point, you will suffer physical consequences. Your life message is stored in your body.”[72] The best way to improve the health of your body is to start by improving your mind. For example, some experts theorize that cancer is nothing more than mental despair experienced at the cellular level.[73]

The mind and body communicate with each other constantly in ways that we are not aware. It would take a trained therapist to root out the possible mental beliefs and attitudes that are behind patients with the recurring medial problems. To discover what the mind is doing to poison the body, an experienced therapist must get beyond the conscious verbiage. Most people talk a good game, and to the untrained observer, one would not suspect that there might be a hidden ‘will to die’ hidden in the background. People often unknowingly use the toxicity of a sickness to achieve ends that they cannot achieve in health. “Sickness gives people permission to do things they would otherwise be inhibited from doing.”[74] Some patients are subconsciously using an illness to gain what they believe cannot be acquired any other way. The remedy is to help them discover creative life-style changes so that their unmet needs flows naturally without an illness as an excuse. If these subconscious motives can be discover and treated, the patient’s mind-body link has no further reason to keep the illness, and their illness will be miraculously healed on its own. An insightful doctor will ask their patient a series of questions to eliminate the mind-body cause of an illness. They ask the patient what they think might have caused this illness, what threats and losses does it represents to them, and how they believe it should be treated. The physician who begins treatment by asking the patient explorative questions often is surprised by what he find when the patient answers the question, "Why do I need this illness?" By listening careful for how a patient answers causal question, the doctor may find useful clues as to what life style changes are needed to clear the path to wellness.

One demonstrated aspect of the mind’s power to heal is called the Placebo Effect, wherein, an induced belief by a person of authority administrating a treatment plan is sufficient to heal, even if the treatment is nothing but a sugar pill. Nearly all primitive medicines use the placebo factor in effecting a cure. A positive placebo effect takes place in a patient if these conditions are present: 1) the meaning of a illness is changed positively by the a physician’s attitude relative to the intended treatment, 2) support is provided by a caring group who also believe in the effectiveness of the treatment and collectively, they all act as if the treatment was working, 3) the patient is permitted a sense of control and mastery over their illness via the treatment plan.

Faith healers of all kinds rely on the patient's belief in a higher power and the healer's ability to act as the conduit of healing energy and channel for the benefit of the patient. We all have this healing gift within ourselves. The power of suggestion and hence the placebo effect depends on trust in the physician and our own beliefs. Those who survive their illness seem to have developed the power to effect and shape their own healing beliefs.[75] If you don’t know what else to do while you are sick, read a few positive, uplifting books, watch some humorous movie, anything to get your spirits lifted.

Life can be hard and harsh at times, but difficulty tends to strengthen us. Thus, besides the obvious normal stress, turmoil of struggle, and challenge, there are also beneficial side effects that we often fail to observe. For one, struggle makes us aware of our mortality. The prospect of limits to our earthly life induces us to make positive changes as part of any solution to our personal problems for overcome hardships. “If a doctor cures a patient’s cancer or disease without also ensuring that that the treatment addresses the patient's entire life, a new illness may appear in its place. The mind and body are connected and until the medical profession learns to treat the illness as part of a mind/body problem, healing will be tentative and elusive.

Chapter 7 - Pain and Suffering

A key aspect of a good death, when it comes at the end of good life, is one without undo pain and suffering from adverse symptoms that inhibit living a high quality of life even at the end of life. There is no reason to let the fear of death rob one's spirit and willingness to live life as fully as one is able. Living life fully is the best to avoid illness in the first place. Maintaining health is both the best prevention and treatment to any ailment should it arise. By stoking our will to live, we activate our survivor mechanism deep within our subconscious and hence the power to heal ourselves.

Some pain and suffering in life is to be expected, and so is stress from challenges which are natural and necessary as the prerequisites for growth and the impetus for change in one’s life direction. Despite the problems and challenges life places in our path, most people are more comfortable with their own headaches, because in some way, they have chosen them as part of their life drama. However, suffering more pain than necessary to achieve one’s chosen purposes is counter productive and unhealthy. An illness often has side effects that cause pain and suffering, which in most cases is unnecessary and undesirable. Pain needs to be relieved by medical interventions.

Pain

“There are different types of pain such as soft tissue pain, bone pain, and nerve pain which need to be treated differently. Pain that comes only at certain times, and in specific blasts, is described as acute. Pain that comes episodically is called intermittent. Pain that persists on and on is chronic. Chronic pain may lead to significant changes in personality, lifestyle, and functional ability. More than half of all Americans spend the last days of their life in pain, more than half of which could be controlled but isn't due to mistaken attitudes of the medical care takers.”[76]

“Pain management is an important aspect of a good death. If the side effects of the medication used to treat symptoms and pain become worse than the disease, then other medical solutions must be found and tried. As a general rule, for pain control, give as much painkiller as required to relieve the pain or until side effects occurs. Then, when side effects manifest, treat the side effects. Enough pain medication is whatever works to relieve pain for that particular patient. What the dying patient wants is to be out of pain and suffering, not necessarily to die.”[77] Enough pain medication is whatever it takes, without qualms for other implications, even if it creates conditions that may lead to a quicker death.

“Complicated deaths are not atypical. It's not easy to control pain. Treating pain requires a tradeoff with various symptoms and side effects,. It's all relative, balancing uncomfortable symptoms versus pain.”[78] Still, the responsibility lies with the medical profession to provide the best end of care possible consistent with pain, suffering, and symptom abatement.

“Morphine is the gold standard for the treatment of pain. Morphine and other narcotics could be administered by oral suspensions, sustained-release capsules, intravenous drips, patient controlled pumps, skin patches, and/or catheters implanted in specific areas. The Brompton Cocktail gives pain medication in steady doses around the clock, so pain never has a chance to peak. There are many pain control options so that a patient need not forgo treatment for pain with addictive drugs like morphine in the mistaken belief that the patient’s system will grow too tolerant and that the pain drugs will become ineffective when symptoms get worse. Higher dosages and different opiates are options as the disease progresses. Don't limit drugs to treat pain and suffering for fear of an overdose. When narcotics are used for pain control, there is little risk of addiction. The biggest problem for patients is the believability of their complaints about pain by care givers and their doctors. Always believe the patient and error on the side over prescribing than under. Chronic pain can last for months or years before a patient dies, so there is no good reason to under treat the patient’s pain and to allow unnecessary suffering. Pain relief is always the right thing to do when someone is dying, even if the higher doses contribute to the unintended consequence of an earlier death.”[79]

“If pain does not abate from treatment, then there is the alternative of using nerve blocks in specific regions of the body or epidurals. Putting the patient into a sedated state of semi-unconsciousness is another option. Demerol is a pain medication that often allows dying patience to live a more normal live at the end. At all costs, the end-of-life treatment must avoid excruciating pain, the humiliation that symptoms cause, and the despondency that come from the near disintegration of the self.”[80]

Just the promise of unconscious sedation makes the pain bearable for the terminally ill patient even if they are in pain to some extent, thus allowing them to bear their agony a little longer. Most people would rather have pain relief now than to live longer with pain. Merely knowing that there is a doctor who will assist in dying when the time comes not only lifts depression but gives a sense of control and the ability to tolerate the intolerable a little longer. Knowing one has a fail-safe method to avoid unbearable pain and suffering towards the end can give patients a sense of control, a confidence to endure more suffering, and a belief that should things get too bad, the means to a quick end are at hand. To aid the patient in completing the final chapter in their life, which is a good death, including both the mental and spiritual aspects as well, the patient’s pain and symptoms must be treated. “The key element in a peaceful death is relief from suffering however the patient defines it. Loss of dignity was given as the main reason for requesting help in dying followed by intolerable pain, unworthy dying, dependence on other for care, and just plain being tired of life.”[81]

Symptoms

“Terminal cancer patients have on average 13 different intolerable symptoms that need to be ameliorated.” [82] At time of death, there are likely multiple organs that are as close to collapse as the one that ultimately brings death. All symptoms that cause pain and suffering need to be treated in some form or another. For the dying who are nearing death, medical care is not directed towards cure but towards symptom control to promote the quality of life at the end of life.

Physical pain is not the only reason people ask for help in dying. There are other categories of distress including despair, hopelessness, grieving for loss of physical functions, loss of control over the body, sparing loved ones, etc. Allowing a patient to lapse into a sense of hopelessness, helplessness, and despair should be avoided at all cost. Caregivers who can assist patients in reducing psychological stress and anxiety improve their disease fighting abilities, increase their immunity, and live longer than those who don't. Terribly ill patients can suffer fatigue in the form of exhaustion of physical, emotional, spiritual, financial, familial, communal, and other resources that normally promote and support the will to live.[83] A good death deals with and treats all of these adverse conditions that are detrimental to a high quality life during the process of dying.

Chapter 8 - The Medical Profession

Doctors often see death with a mission to cure, not to care for a dying patient. It's as if the medical profession thought that death was curable in all circumstances, and each individual disease, if properly treated, could be cured and would not lead to death. There are other missions that the medical profession can be called upon to perform, to manage a good death at the end of life.

The medical profession has a clear and distinct role to play in the process of death and dying. However, once the decision is reached to preclude further medical treatment in the progression of any disease, as a prelude to dying, the alternative medical track is palliative care to ensure a good ending - a good death. The medical profession is key to the administration of drugs to reduce pain and suffering and to offset serious symptoms to the quality of life.

Medical care should be directed along two parallel paths, sometimes both at the same time: 1) cure and living and 2) assistance for transcendence into death. All standard medical treatment achieves, by itself, is a prolonging of the act of dying. Medical treatment should do more than prolong dying, it should include improving the quality of life and a good death at end of a good life.

Medical Care

For complete and effective healing, the medical profession should not try to treat only the body but incorporate philosophy, psychology, and spirituality into their treatment plan.[84] At present, the purview of the medical profession is far too narrow, treating only the diseases and illness that affects the body despite common knowledge that the mind and body are a functioning whole. The medical profession needs to heal both the mind and the body rather than just the body alone. A joint mind-body treatment plan would add other dimensions to the medical profession. It would both add cost treatment and at the same time reduce cost as there would fewer instances of sickness and disease.

In the future, medical care may become rationed due to limited resources and prohibitively higher costs. If so, then the decision for allocating limited medical resources should be based on what is the most cost-effective medical interventions that are known to work. By working on any illness or disease as a joint mind-body problem, there is great potential for both less bodily treatments and greater cure rates. So, on the one hand, medical costs might rise by adding the joint treatment of the mind, but medical cost may also drop because the higher overall effectiveness of less costly treatments.

Since the mind is a powerful healing agent, the physician needs to harness its power from the very beginning. “A physician's habitual prognosis of telling the patient how much time they have left to live is a terrible mistake. It's a self-fulfilling prophecy and it activates the placebo effect in reverse. What the physician needs to tell the patient is that they are the exception to the rule. The words ‘terminal’ should never be used in front of a patient, because it means that the doctor is treating the patients as though they were already dead. The word, ‘terminal’ implies a state of mind of the physician more than a physical condition.”[85] The physician should never remove the prospect of faith and hope as it curative properties are well known. No statistical prognosis should ever be given without leaving the door open to hope and to miracles. “If a patient responds to prognosis with resignation, the doctor's job is to convert them into fighting survivors.”[86]

Responsibility

People who recover from an illness tend to believe that their cure was the result of a long, hard struggle that they had won for themselves.[87] To promote a faster recovery after treatment, the patient needs to assume complete control and responsibility for their own recovery. The patient must muster all the survival instinct they can summon as well as resolve to get back on their feet as soon as possible. During any hospital stay, they must get up and out of bed and walk as much as possible when appropriate. When entering the hospital, they should take with them items of a personal nature to remind them of all they have to live for. They must attune their mental disposition towards recovering and healing. They need to bring inspirational reading material, cassettes and videotapes, inspirational music and consume them to the maximum extent possible during medical treatment and convalescence. They must demand of the hospital staff to avoid any negative statements in your presence and especially during surgery when you conscious defenses are down. One can even invite the surgical staff to make positive suggestions for particular bodily organs to increase or decrease functioning (depending what would aid the surgery). If at all possible, take a tape recording of positive auto-suggestions (affirmations) into the operating room for the subconscious to listen to during surgery. Harness the power of positive suggestions to get well and heal.

These positive practices should be continued after surgery or medical treatment to ensure faster healing. Get your body up and moving again as soon after surgery as possible. “Get walking as soon as possible after surgery. During recovery, stay active, spend time in activities unrelated to the illness, resolve unfinished business, continue and build new and better relationships.[88]

Diagnosis and Prognosis

Before any treatment is commenced, a physician must provide a diagnosis and prognosis of the disease. One must understand that any human diagnosis, physicians included, is fallible and prone to the training and biases of the source. Thus, physician recommendations for treatment of ailments are more informed trial and error based on their and others research and experience. Not only might the recommended treatment be wrong, but so might the diagnosis. Ultimately, it is the patients who must decide what course of treatment to follow.

A physician can be honest with a patient regarding the prognosis, telling them the reality of the situation, the exact nature of their illness or disease, and still offer encouragement and hope. Anything the physician can do to activate the patient’s faith, hope, and optimism will leverage the power of any treatment plan. The physician serves best by helping the patient find reasons to live, even if they have to team with the mental health profession to do so. Helping a patient come to grips with their emotional issues and self-acceptance leads to better physical health regardless of the treatment selected.

Standard Medical Model for Treatment of Disease

Not all diseases can be successful fought and cured. Sometimes, there is nothing that can be done within a reasonable probability of cure, especially in advanced old age. “One should not let the medical view of death prevail, that any disease must be fought to the end. Death is not a malady that can be outwitted and successfully fought.”[89] In the end, death wins; it is only a matter of time. Sometimes the treatment and cure is worst then the disease itself. In the end, death cannot be defeated, it can only be, and then, only at a cost in loss of more pain and suffering. At best, the right and proper medical treatments during the process of dying can ensure that death is not a long, slow, living hell.

“Congestive heart failure is the most common cause of death in the USA due to arrhythmia, and instantaneous and unpredictable electrical misfiring in the heart. Some interesting treatments for common heart problems include Artherectomy, wherein the insides of a blocked vein can be gored out with a microscopic knife to remove blockages. Stents or tiny thin tubes can be put into blocked arteries to expand them and relieve blockages.

Serious side effects occur during an illness when patients get so incapacitated that they cannot move. Their immobilization causes their lungs to slowly fill with liquids. Pneumonia often sets in when a patient cannot make physical movement and often becomes the cause of death. Interestingly, the last organ to malfunction near death is hearing. Always assume that the patient can hear what is being said around them, and continue to offer words of encouragement and endearment.

Non-Medical Assistance

There is no reason why palliative care for the dying cannot come from other care givers besides the medical profession. Why should the physician have to assist in dying, why not some other profession? But first, the medical profession must change its views on dying, including the following aspects[90]:

“We need to reshape our social institutions so that the end of life can be the best of life.

Society

Modern society has transformed the way people live and die. In the past, death was primarily attended to by families with only a minimum of intervention by the medical profession. Medicine has become a growth industry, attempting to regulate all aspects of heath and cure. “Americans have traded the stress of constant and capricious loss from death for the emotional and financial stress of long-term, high intensity caring.”[92] To achieve a good death at affordable cost, society must change in substantive ways how it administers and dispenses medical care.

Chapter 9 - Legality and Society

The fundamental right everyone ought to have is the right to a good death and ability with medical assistance to die peacefully (free of pain and stress). As the dying person nears death and in pain and suffering, the patient’s desire to hasten death is not legally or socially sanctioned. Just because assisted suicide can be done doesn’t mean that it should be done. However, assistance in achieving a good death, that is free of pain and suffering, should be a right afforded everyone. “In one way or another, assisted dying is how nearly everyone is going to die.”[93] This legal issue is how much assistance and in what form to render aid in dying. From a legalistic perspective, there is an important distinction between letting one die and aiding in their dying.

The Legality of Assisted Death

Law and society takes the matter of life and death, seriously, and regulates all decisions affecting both life and death. “The state has an important interest in maintaining a clear line between physicians as healers and a profession that cures and physicians as instruments of death of their patients.”[94] The legal establishment has debated an individual’s rights to a quick death through assisted suicide and some early conclusions are beginning to emerge. First, a person’s right to a good death is acknowledged and so is a patient’s right to withhold medical treatment near the end of life, when a cure from disease or infirmary is beyond reasonable hope. “A quiet, proud death, bodily integrity intact, is a matter of extreme consequence.”[95]

Second, assistance in hastening a patient’s death except from natural causes is not sanctioned. Experts on the subject of assisted death have concluded that there is a fundamental difference between assistance in the dying process, wherein a patient is assisted in dying a painless death, and active assistance in killing them to spare them further pain and suffering. Withholding, withdrawing, or refusing treatment is the only way most Americans are now permitted to die sooner rather than later. Allowing nature to take its course is a medical option, in parallel with palliative care. Even then, this option is permitted only after a physician officially renders a judgment that it is apparent that further medical interventions would only prolong dying and adding to suffering. When a vital body part fails and the patient has signed a ‘do not resuscitate order’, it is clear to all medical personnel that the patient is being managed towards death. Letting a patient die a natural death (passive) has legal support but allowing or aiding an early termination (active) does not.[96]

Despite these stringent, legalistic guidelines, there is considerable gray area in the matter of guiding death to an early conclusion when there is no hope for further quality of life. For a physical to give the dying patient sufficient medication such that high doses are necessary to preclude pain and suffering, and might have a side effect of rendering an early death, is part of that gray area. Furthermore, there is always the prospect that the patients might overuse the pain medication by themselves, as a means to hasten death is another gray area. A physician would not be condemned who provided a suffering patient with high does of medication to ease their pain even if it might be abused. “It would not be consistent with good medical practice for a physician to refuse to treat terminally ill patients for anxiety, insomnia, or pain just because they suspect the patient might use the medication to end their life.”[97]

Few patients, who is dying but still living a quality life without pain, suffering, or unbearable side effects, would desire an early end to life. So, if sufficient palliative care is offered, there is little incentive to self-administer a fatal does of medication. “Opponents of assisted suicide argue that proper pain management and the treatment of depression will eliminate a need for assisted suicide.”[98] Again, the terminally ill don’t necessarily want to die, they just don’t want to suffer anymore the physical and mental pain associated with dying. If there is good end-of-life care, then the need for an early end-to-life assisted suicide would become not only unnecessary but undesirable.

Medical Insurance

One innovative concept for health insurance is a demand by the insurance provider that the patient take better care of themself using exacting (observable and measurable) requirements, such as controlling smoking/substance abuse, weight, exercise, etc.[99] The greater the number of health risk factors a person places in their life due to poor choices and life style habits, the higher should be the cost of the insurance. Likewise, the healthier the life style and the lower the number of health risks, the lower the cost of the insurance. It stands to reason that the people who will need more health care should be required to pay more for it.

Chapter 10 - The Process of Dying

Death and dying is a process. Each death is unique and follows its own path. However, the stages of dying and the process steps of dying is fundamentally common. These common aspects of dying can be managed and directed towards the goal of a good death. A process leading to a good death should be the goal of every person so that all the business of this life is wrapped up so that they can move to the next without trepidation.

Death is the point of maximum or infinite change that occurs during a person’s lifetime, even a greater change than birth. Biologically, we know how life is created, and it progresses in stages so that no one stage necessarily is the peak moment, unless it be conception and birth. But at death, the cession of life is extreme…everything that was, suddenly isn’t

No one knows what to expect at the instant of death, as there is no way to find out dn still come back to report it. There have been reports of near-death experiences, that are remarkably common, but still there are doubts as to whether these reports are really that of death or just a logical consequence of a bodily malfunction. There are few extremes as wide as life and death, and so, death is widely considered by most people to be the point of greatest change in a person's life. Life progresses and changes at different paces throughout life, but at the moment of death, when it comes, the transition from life to death comes quickly.

Change as dramatic and extreme as death needs to be managed, if one wants to achieve a good death, however one might define it. The end of life needs to be organized around the transcendent nature of death, a spiritual passage from all that ones has and knows to an unknown state of existence. “If a person's life can be reorganized around something of a more noble nature, a purpose larger than one's self, suffering often eases, even in the midst of a difficult dying process.”[100]

Fortunately, one of the gifts of dying is the ability to shift reality and consciousness from oneself to the greater or universal consciousness. An prescription and preparation for dying should likewise devote considerable attention and time to delving within this realm of universal consciousness.

Dying is Process

The process of dying will require new routines to make the last stage of life the best of life. The forthcoming of death is a progressive acceptance and an embrace of nowness in the face of nothingness, that the end could come at any time, and the more unfinished business is brought to a closure, the better. Even on one’s deathbed, one should live like they could die at any time, and sooner than they expected. By putting their reminding time to good use, what they accomplished before they die could be the best that they have ever done, thus giving them a sense of completeness, closure, and heritage for posterity that makes death easier. The fewer things we regret not doing during life, as we approach the grave, the better.

“Patients go through five emotional stages during death and dying: denial, anger, bargaining, depression, and finally, acceptance. Helping people navigate these phases is an art than can be learned. These five stages are called the resistance stages. Two additional phases of dying are called 6) finishing old business and releasing oneself from earthly burdens and purposes, and 7) transcendence into the next life.”[101] Everyone goes through these stages at their own rate, sometimes skipping many steps as they journey. In the end, comes complete surrender to the undeniable call of death.

Signs of Pending Death

Most everyone dies due to the exhaustion of a vital organ. As the body approaches impending death, associated organs begin to shut down as well. “Not eating is the body's way of getting ready to die. Dehydration is the body's natural way of shutting down. An electrolyte imbalance allows dying patients to drift off into a painless sleep rather than fight for breath as the lungs begins to fill with fluids. The body's natural and normal way to die is by starvation and dehydration. It's the body's way of anesthetizing itself. Without food and water, the body slowly shuts itself down, as it producing its own anesthetic, and the patient slowly gets weaker and sleepier.”[102] With labored breathing, as the lungs fill with bodily fluids that produce a shortness of breath, narcotics, such as morphine and other opiates can reduce the feelings of suffocation or discomfort.[103]

The dying person sleeps progressively more and more as their inner world and sense of reality changes. Their dreams become more real than reality. When the dying report visions of them interacting with people who have preceded them in death, it is a clear sign of approaching dying. Some experts in dying believe that visions of dead relatives or friends help the dying patient move from this world to the next. It is comforting to believe that no one dies alone. Ultimately, as one leaves this world, they slowly release their powers to that of the almighty.

“No matter where we are in our stage of dying, it's what we do with our time now that's important. Even during the process of dying, there is a chance for each of us to make our life journey whole and complete. The dying process can teach us to open to the mystery of life, perhaps some clarity as to what one’s life was all about, and to share our new profound understandings with the loved ones around them. In an attempt to leave a lasting mark, some have made a tape recording of their personal journey from life to death experience.”[104]

Children

Children seem to have the most potential to move through their dying process with grace and equanimity.[105] “Most children report talking and seeing someone who is waiting for them when the die, and then they die. Dying children have fears of leaving their families, and dying in their sleep. They might need to be reassured by being held, sung to, and stroked.”[106]

Chapter 11 - Death is the Final Step to Life

Death must be put into perspective in order to understand and deal with it. Since death is something that everyone must go through at the end of life, it is a fact of life and must be accepted. Everyone wants two things out of life. First, everyone wants to live a good life, however they define it. Second, everyone wants a good death, and again, a good death is however one defines it.

To achieve any goal, such as a good life or a good death, one must take charge and manage it. To achieve a good death, what this means to the person who wants it, must be defined in enough detail that any care giver would know they were providing it or not. Without clear specifications, one would not know if they were or were not getting the good death they so desired. Specificity is key to getting what one wants in life and in death.

Without clear specificity of what we want out of life, we could end up with anything or nothing.

Depression is a psychological condition as defined by psychologists that generally involves quitting and giving up on life.[107] The common denominator in all depression is a lack of sufficient love from self or others or a loss of meaning in their life. Illness often serves a function…an escape from a routine that has become meaningless. Depression is a leading cause of illness because it lowers as person’s immune system. When immunity is at low ebb, the body becomes highly susceptible to disease. “Anger, depression, and all the other negative emotions are responsible for the vast majority of human ills.”[108] A person’s ‘will to live’ instincts tend to languish during depression, as one’s life force seems to be to have lost is power.

The most important casual factor in the onset of despair and depression is usually a change, usually a loss, within a person’s environment or comfort zone, about which the person feels powerless, hopeless, and helpless to correct or recover.

Since everyone’s live ends in death, we are all equally mortal. We differ by what we do before we get to the end of the road. “There is an end of the road for everyone, despite how much effort we make in pushing it off into the distant future, so we must make choices on how best to utilize the limited time we have. No one knows exactly when they will die, and within that uncertainty, we all have almost unlimited options. When we do eventually awaken to our own mortality, we need to take an action by refusing to live a life that fails to bring us joy. People need to wake up and live. Sometimes it takes the knowledge that we won't live forever, to get us to try harder to live a life worth living during the limited time we have left. There is nothing to be gained by hanging on to our fears, especially those fears that prevents us from loving other people unconditionally.”[109]

Dying is a process, a progressive loss of health, vitality, and the will to keep on living. Once it the process of dying begins, baring a miracle, dying is an irreversible progression of diminished capacity of all physical and mental functions. To offset these losses is an equally progressive rise in the dying persons spiritual essence, even if it does not manifest to observers. “The process of dying need not be terrifying, frightening, or painful. There is no one correct way to die.”[110]

Death

A the end of the dying process comes death. Death is the termination point of a transition every living creature makes as it transcends from one of relative health and vitality to one of the exhaustion of bodily resources capable of sustaining life. A good death must include both a good transition period from health to near death and also a good final exit at the end point of the process. Ideally, the dying patient is fully functioning, conscious, and actively engaged in both living and dying throughout the process. Ideally, the dying patient is living a satisfying life, to the maximum of their capabilities, and deriving satisfaction from the mysterious and spiritual experiences that await us as death approaches.

The key to a good death is keeping the discomfort and liabilities of a failing and decaying body to a minimum, controlling pain, suffering, and symptoms from interfering with peace and tranquillity that are the hallmarks of a good death. The role of the medical profession and caregivers is creating the necessary conditions for a good death, even if the patient must receive heavy does of medications to control the adverse physiology of dying. In a worse case scenario, the patient may require ‘sedation to unconsciousness’ near the end of life, which is a permitted medical option because physicians are permitted by law to end suffering.

The closer the dying gets to death, the more the body’s own natural mechanisms take over to ease the final step. “In death, the body slowly shuts down, putting itself into a natural, self-anesthetizing sleep.”[111] For family, friends, and caretakers in the presence of the dying, always assume that the patient is able to hear all that is said and judiciously use the right words for the right reasons. “Even if the person on their death bed is unconscious, speak as if they can hear.”[112] In the days before death, “the language of the dying becomes progressively more symbolic. If you listen, they give you a glimpse of what’s on the other side, because they are sitting by a window on one side peering into the next world. Most people report seeing visions of lost relatives and friends.”[113]

It is possible that people approaching death become confused, perplexed, and anxious. The experts who study death suggest that as the dying slip towards death, they simply be directed to close their eyes and meditate on the light. “Go towards the light. Look for relatives and friends who have gone before you who are coming to bring you home. In dying, one can let themselves float endless outward, progressively moving towards the brightest light, connecting their mind and spirit with the universal consciousness while letting go of one's connectivity to self. In dying, if you should get to a point of fear and panic, simply let go and dive into it with full awareness. Allow your thoughts to flow freely for this in the time your sub-consciousness is trying to communicate with you.”[114] If you are receiving care from others at the time, the more of these near death experiences you can get them to articulate, the less anxiety for the patient and the better death can be understand by those still living. Making sense of one’s experiences during a time of profound change in state from living to death is likely to be overwhelming, especially since the patient is suffering from severely diminished mental capacity. Helping the dying make sense of what is happening to them helps guide they way and attenuates fear of the unknown.

Death becomes easier if one has practiced it. Death is not unlike any other performance or skill, it can be learned. “The moment of death can be prepared for by 1) recognizing its presence, growing comfortable with its coming, and allowing for its possibility and inevitability, 2) creating a powerful imaginary image and trying to merge one's mind with this image.

The more often the dying experiences these near-death moments, in a calm controlled setting, the more they readily they are trained to accept the end and the release of life at the moment of death.[115] What happens at death is a release and transformation of the spirit.[116]

Some deaths occur quickly when a vital organ fails completely, due to stroke or heart attack, or accidents that cause great bodily damage. Otherwise, humans live in relatively good health until disease or body organs begin to fail as they wear-out. If a disease or body organs failure progresses to a point of no return, the focus of treatment shifts from cure to comfort as the body begins the dying process. Ideally, everyone will live with every measure of life that still resides within them. A good life is one described as living as well as one can for as long as they can. Unless one is dying, one should be focused on living life to its fullest in everyone way imaginable, for as much as we know, we only get one chance at living.

Unfinished Business

Every death occurs within the context of our total lives.[117] No one knows the exact link, or even if there is one, between having lived a good life and experiencing a good death. It is possible that having lived a good life makes death easier, as there is less unfinished business, loose ends, and regrets to deal with. Still, even if one has not gotten all they hoped and dreamed of during their life, they can still experience a good death if they make the right preparations and follow the prescriptions suggested in this handbook.

Taking care of unfinished business may someday be recognized as the most effective way to avoid undo stress, anxiety, and pain known to man. Not only does one avoid having to deal with unfinished personal business during a downturn in their health, but closure is conducive to healing. Closure is also an inoculation against disease, mental preparation for surgery, and motivation for rapid recovery. Forgiveness and confession is a form of closure that are good for both the body and the soul. Also good for both the mind and body is sharing sorrow with someone else, as it tends to protect people from the stress of loss.[118]

Denial

The people who have the most trouble with death and dying are those who have not yet lived a good life and don’t want to die lacking the fulfillment of their hopes and dreams. “We are a death-denying society, because we are unfamiliar and misunderstand death. We have little guidance on how to die.” However, getting to the point of acceptance and readiness to enter a new, unknown realm in the hereafter is the last phase in the process of dying. “Those who keep hoping and fighting for a longer life and putting death off into a distance future, tend to survive and live longer…but not necessarily achieve a good death.”[119] It seems the ‘will to live’ aids one’s psycho-immunology strength. However, to prolong the process of dying does not avoid it altogether and does not necessarily lead to a good death, unless the extra time gained is spent in achieving an important closure or chapter of one’s life. “Death is often resisted by a dying person if they have significant unfinished relationship business. The care giver must help the dying finish their unfinished business.”

Quality of Life

A good death is synonymous with living a high quality life during the process of dying. “Few terminally ill patients want to die, but all want to stop living the way they are forced to as a result of their disease. Provisions must be made for the dying person's diminished abilities and to accommodate any loss of ability with substitutes of equal value. With relief of pain and serious side effects of the disease, one can continue to live in a manner as they choose until the day they die. It is important to help people who are dying live as normal a life as possible so they can live a quality life, even at the end of life. The mission of the medical treatment at the end of life should focus on allowing the patient to function at their highest possible level. The end of life is a magical time with possibilities for ecstatic and mystical experiences that no one can imagine.”[120]

Therapy

To reach the point of closure, acceptance, and readiness for the terminal point of one’s life, the dying may need psychological assistance. If ever there was a life event that requires one to get their ‘head on straight’, the process of dying is one of those events. A trained therapist can greatly aid the dying with a “life review process, a mental reframing by taking stock and reintegrating fragmented pieces of a disjointed life into a unified panorama of the dying person’s life. Death counseling is a therapeutic tool that can greatly aid in the dying process.

Values

One’s personal values and beliefs in the importance attached to things tend to change during life. This especially true during the process of dying when there is a profound shift in the value placed on physical things to an increased rise in importance of virtue, relationships, and spiritual connectedness. “At the end of life, what matters most is love, touch, and connectedness which helps ease the burden of the journey.”[121] It's the losses that one must deal with, when the things that matter most and by which one values oneself are gone, that the dying person may begin to believe that life may not be worth living.[122] However, no matter how much physical capability and earthly possessions are lost, the highest order needs of peace and tranquillity are gained. “It may not be until we reach the end of life that we find out just how important things like love really were. Death is not the worst tragedy in life. A life without love is far worse. Some people believe that when you die, you can take the love with you.”[123]

Chapter 13 - Choices

Life is nothing if not choices we get to make. Not only do we have choices during our entire life span, but we also have choices as we face death. To achieve a goal of a good death, one must make a set of good choices both before and during the onset of dying. “One may wish to die as and when they choose, not when death summons them, but when they summoned death.”[124]

Alternative Treatments

Allow the patient to make choices but never force them to make choices alone. A doctors needs to help patients make tough choices as to both their treatment plan as well as a palliative plan for achieving a good death. Choices for healing as well as a good death are not limited to traditional medical profession offers.

A integral part of treatment should include music, creativity, mental therapy, meditation, and laughter. Every treatment for illness and disease should include supplemental medical treatment that includes love, caring, and death-and-dying counseling. Some alternative treatments might include intravenous Vitamin C, daily meditation sessions, consultations with a nutritionist, and subliminal messages (affirmations from a computer). Healing can come from many sources, including changers in nutrition: less fat, more fruits and vegetables, and whole-grain cereals. Some former cancer patients attribute their recovery to strict dietary regimens. Statistics have shown that vegetarians with cancer have better survival rates.[125]

Activity and movement are important to quality of life. Active people are healthier. People who exercise live longer. So, exercise is important to the quality of life. But don’t be driven to conclude that exercise must become a chore or work. Unless activity and exercise is fun, it is self-supporting and ultimately, the exercise will cease, thus defeating its good purpose. To last, exercise must be enjoyable or at least not painful. When you can't or don't feel like exercising, visualize yourself exercising. An personalized exercise plan can be as simple as finding some activity one enjoys doing and then overdo it.

Besides activity and exercise, both relaxation and laughter is good therapy. The relaxation response after a good laugh or strenuous exercise has been measured as lasting as long as 45 minutes.

Prayer is also good therapy. Prayer consists of focused talking, meditation is listening by our spiritual self. Mediation is the ability to acknowledge other things, deeper thoughts and feelings, the products of our unconscious mind, the peace of pure consciousness and spiritual awareness.[126] Writing about one's stresses helps to relive them.

One of the most powerful of all alternative treatments is simply changing one’s life for the better. We all have choices to change or not in the face of stressing circumstances. However, change is tough work. Even though dissatisfying, established patterns and habits are easier to blindly follow than the harder work to change them. Change is just too difficult for some people to handle, and the unknown aspects of change is deemed too risky, uncomfortable, and frightening to contemplate. The emotions associated with change are not nature’s way of holding us back, but instead, they are just intended as signals to let us know we are in the process of changing. The better physicians allow their patients to make treatment choices based on what would feel right if they knew they were going to die in a day, a week, or a year. When change is necessary, the best way is to ask what changes you’d make if you only had a day or two to live.[127]

When it comes to treating pain and suffering at the end of life, there are many more options available than the medical profession is likely to allow from its own toolbox. For example, eastern medicine focuses on revitalizing the body's immune system so that the body itself, rather than drugs and chemotherapy can fight off the illness. By recognizing the power of the mind-body linkage, the physician can recommend complementary psychological services to treat any overt symptoms of a ‘will to die’ due to low self-esteem issues and invite practices that elicit a positive Placebo Effect to contribute its inner healing effect.

Healing Energy

A body heals itself from the inside out. “The body can use any kind of energy for healing, even plain water, so long as the patients believes in it (Placebo Effect). Energy is vital for life as the life force itself is energy. One must put energy into life to get energy out of life. Healing energy is derived from the resolution of conflicts, the realization of the authentic self, spiritual awareness, and the love released from the increased awareness of the temporal nature of life.”[128] God is the highest and most powerful healing of all energy resources, so we certainly want to drawn upon that source to its fullest through prayer.

Any negative energy for unresolved conflict must be released so that it does not drain our supply. Often, this negative source of energy is called unfinished business. Closure ends that energy drain, however the patient defines closure. Turn the negative energy of and residual hatred and revenge into positive energy of forgiveness and love. Love alone has the power to save your live.

Expectations

People will prove themselves to be right about whatever they believe regarding adverse or positive side effects from any treatment program. A doctor must manage his patient’s expectations so as to harvest its positive effects and avoid its negative consequences. A physician can instill hope and positive expectations into any treatment, if they just suggest that, ‘A lot of good things could happen because of this treatment. It is possible the following adverse effects could happen, but I don't expect them.’[129]

A patient’s unconscious can be strongly influenced while they are anesthetized during surgery. The physician can suggest to the patients that they direct certain parts of their body to function in supportive ways during surgery and to prevent surgical complications. For example, patients can be given instructions to slow bleeding in certain areas and to control their pace of breathing Under no circumstance should the surgeon permit the themselves or their team to use negative messages during surgery as the anesthetized patient's conscious defense mechanism are fully functioning. Operating room staff should never say anything about the patient that they would say when the patient was awake.[130]

Two major mental tools can be used to harness positive energy within the body during the healing process: our positive emotions in the context of directed imagery. By envisioning healing, we can help the body bring them about. Since the body and the subconscious cannot readily distinguish between a vivid mental experience and an actual physical experience, why not take advantage of this phenomenon and use the imagination to induce healing. Imaging positive outcomes channels mental energy towards making the desired result happen. As you begin to act upon your new awareness, you create new opportunities and energies both consciously and unconsciously. Sit quietly in meditation and listen to the messages coming from deep inside and heed their warnings. Meditation allows the mind to focus on images of healing. One can meditate on a single image, symbolic sound, or just the ebb and flow of the breath.[131]

Meditation even in good health tends to promote a continuation of good health. Other benefits of meditation include the raising of the threshold of pain and reducing one's biological age. It's benefits are multiplied when combined with regular exercise, yoga, relaxation, and nutrition. Relaxation and meditation have been demonstrated to reduce the need for insulin among diabetics.

Anyone involved in caring for or healing the ill needs to be trained to help the patient mobilize their mental powers against the disease by building not only the hope of recover but the will to live. Besides mental imagery, other alternative treatments include affirmations, and meditation. Music has demonstrated healing properties that have been known since biblical times. Music opens a spiritual window. Music eases anxiety.[132]

To find the best alternative treatments, the medical profession should not only study its failures but also its successes as well, especially successes from alternative medical strategies. One innovative idea for supplying alternative treatments is a healing TV channel that would include plenty of comedy, as well as music, affirmations, subliminal messages, meditation, and healing imagery.[133]

Good Choices

Every decision leads to a result, an outcome. The power of a good decision is its potential to lead to a good outcome. No set of decisions is more important than the end-of-life-decisions, the ones that are needed to secure a good death.

The more complicated medicine becomes, the more pressure on the patient to feel they should have chosen another treatment option. Death becomes your fault, your failure to properly strategize.[134] One key decision is the choice of when to cease treatment for disease or debility that is pulling you towards death. There becomes a point where the fight for cure is hopeless or the treatment becomes more of a burden than the prospect of death. “When the burdens of treatment begin to outweigh the benefits, the medical treatment of the disease should stop. Decisions about end-of-life care should take into consideration both the invasiveness of the treatment involved and the patient's likelihood of recovery. There is no cultural or medical agreement as to when treatment should stop searching for a cure and to begin allowing the patient to progress into a natural death.”[135] This is the ultimate decision that only the dying patient can make for themself, and perhaps the last great decision of their life. Decisions at the end of life can be the toughest decisions.

There comes a point where life-extending care is replaced by comfort care. At present, there is a inadequate options for at-home care assistance offered by the medical profession. One must seek the best options available which might include hospice or nursing/custodial care. Hopefully, one has made provision with a long-term insurance carrier to defray the bulk of the financial burden for funding these better end-of-life options.

There is a time to live and a time to die. There comes a time when one must choose to shift their mode from living a good life to concluding a good death. The process of dying is time to refocus one’s attention from the act of living to act of dying. “At some point, a person must switch their focus from living well to dying well.”[136]“ In the face of serious illnesses, it is necessary to develop parallel streams of plans. One plan deals with health and recovery and the other deals with death and dying. Both might have to exist simultaneously.”[137] Ultimately, one track or another is selected and the other abandoned. The decision about how and when to die, is one of the most intimate and personal choices a person may make in a lifetime.[138]

Chapter 14 - Preparing for Death

If one wants a good death, they must make preparations for it. They will need a plan of action and set into motion the means to execute it throughout the entire process of dying.

Acceptance

A serene acceptance of “what is”, even the prospect of death, promotes health, healing, and even a good death. Acceptance clears the mind so completely that new possibilities can be seen for the first time. A clear mind allows one to instinctively knows what to do with the time remaining to them.

Attitude

Our attitudes are a reflection of what we believe deep within our subconscious. Our attitudes have the power to either heal us or make us susceptible to illness. For example, appreciation is healing attitude. Our attitudes and state of mind has an immediate and direct effect on our bodily state. So, to stay healthy, one must develop an appreciation for all the good things that remain in one’s life, regardless of how much might have lost to their illness or disease. To promote healing, one must change their focus away from their illness and negativity and begin using optimism and positive imagery as their primary tools for relating to their illness.

The medical profession needs innovative ways to help people change their attitudes towards life and death.[139] A doctor's attitude of faith and hope is crucial to the success of any treatment. The attending physician’s attitude also plays a powerful role even when the patient is unconscious, asleep, in a coma, or under anesthesia. The patient’s subconscious hears everything acutely and will act as if whatever is said is true. Plenty of business opportunities exist for entrepreneurs to create inspirational cassettes and videotapes with life enhancing content to help patients connect with their own life-giving energies. There is nothing so powerful as optimism or a physician’s empathy for building the right attitudes in the patient that are so critical for healing.

Thus, we have the power to change the health of our body by changing our attitude about both our life and our illness. One's attitude towards themselves is the single most important factor in achieving both wellness and healing from sickness. If a patient can be turned from predicting continued illness to anticipating rapid recovery, the foundation for a cure is laid.[140]

One’s attitude towards their current life is just as important as their attitude regarding their healing. If one is not living the life of their dreams, then life changes are warranted, despite the reluctance of change. You aren't likely to survive cancer if you get up every day thinking how much you hate what you'll be doing that day.[141] By changing one's inner attitudes, one can change both the inner and outer aspects of their lives.

A patient’s attitude towards his disease can be changed for the better, but it will likely require an outside change agent who has the training to do it right. Once the patient’s beliefs supporting their negative attitude is surfaced and consciously revealed, so that the patient cannot deny it’s negative impact on their life, these beliefs can be dealt with it in constructive ways. Each negative belief must be changed into its positive equivalent.

The work of uncovering suppressed conflicts between the life one has and the life one wants is important to both the mind-body health. When outer circumstances once again match inner desires, energy formally tied up in contradictions becomes available for healing.[142] There is nothing more healing than peace of mind, which resonates within the body. What is healing if it is not getting people into peaceful state of mind and the motive to live their life to its fullest. On the other hand, depression, fear, and unresolved conflict send a ‘will to die’ message to the body. People who are taught to seek peace of mind and give themselves up to a higher power often succeed in miraculously healing themselves.[143]

Anyone can make peace of mind a goal and achieve it. Peace of mind creates a healing environment in the body. Peace of mind has great powers and can heal anything except death when it is time to die. Faith and hope are essential to recovery, a really simple solution, yet too hard for most people to practice on their own with professional assistance. It is hard to find peace in life if you believe death is a meaningless end or earthly existence is futile.

Stress Control

When we don't deal with our upsetting emotional needs and the stresses it induces, we set ourselves up for physical illness. Stress reinforces illness and must be removed in whatever way is necessary. Pain is a stressor, and as such, whatever pain relief is required should be administered to make the patient stress free so they can devote their conscious attention to healing themselves. In fact, stress is often the precipitating reason people end up with an illness. How a person handles a tragic loss or emotionally stressful change in their life is often the deciding factor in one’s resistance to disease and illness. The way one copes with stress is more important to mental and physical well-being than the actual stress itself.[144]

Stresses that we chose for ourselves, as the way to promote our own goals, evoke a response totally different than those we'd like to avoid but cannot. Stresses from our energies and powers directed to overcome life challenges are not only healthy but protects one from illness. Stress is an inside job. Stress does not come from outside ourselves, but instead, stress comes mainly from our interpretation of events.

Hence, anything a therapist, physician, or caregiver can do to reprogram a patient’s attitudes about their life and their illness is value added to healing. Research has concluded that societies that produce the least stress to its members also have the lowest rates of cancer. These low-stress societies are close knit communities in which supportive, loving relationships are the norm, and the elderly retain an active role throughout our their life.[145]

Routines, habits, and comfort zones provide sufficient security and predictability that most people do not get themselves into too much stress. However, most people error on the side of too little stress, and hence fail to make the changes needed to align their wants with their external circumstances. Even within the relative safety of one’s comfort zone, the misalignment of desires and circumstances is source of stress all its own. Sometime change is the best remedy to these alignment stresses.

Meditation

Meditation practices can be used both to enhance living and as well as preparation for dying. One of the best ways to achieve a good death is to begin preparing one’s mind and spirit to receive death at the end of the process of dying. Meditation is an excellent way to begin connecting with the infinite or universal consciousness. “Buddhism often uses visualizations and meditation to guide both the processes of living and dying. In meditation practices, one can observe death from afar and observe changes in their own consciousness. One’s perception of a death will change over time as one continues to meditate on the universal consciousness. Care givers who assist the dying can render the most valuable aid by mediating with their patients by visualizing themselves breathing for them, through their heart, feeling their anxiety, and communicating love.”[146] If the meditative practice of facing death were practiced daily, then it would help make one ready for the ultimate experience - death when it finally comes. Meditation can simulate the end conditions of death, and the closer one comes to death, the more meditation accurately simulates the conditions that are likely to prevail at the end of life. To meditate, one simply quiets the mind, becomes attentive to their breathing (inhale darkness and exhale lightness), acknowledges their thoughts and lets them go, and searches and explores the brightest light or other unfamiliar experiences they see on the screen in front of the mind’s eye. “A dying person should visualize their soul rising out of the top of their head and the merging of their consciousness with the brightest light imaginable.”[147]

Advanced Health Directive

The plan for a good death needs to be captured and outlined in a document called the Advanced Health Directives (or living will), which specifies how one wants to be treated medically at the end of life. “With a living will, a person specifies what kinds of treatment are wanted and not wanted. A durable power of attorney or health care proxy both requires that one designate some other named person to make health care decisions should the patient not be able to decide for himself or herself. Otherwise, without written consent, family succession law prevails. A health care proxy allows the person/family designated with the power over life and death to make medical decisions but also requires them to live with their decision.”[148]

Legacy

Everyone would like to leave behind something that marks their existence, a permanency that shows that their life made a difference. A legacy of one life story is something that can be bequeathed to one's loved ones and can survive them beyond the grave. A legacy project is one that can be started and finished during the dying process with the assistance of a caregiver, and it can be shared with one’s family and friends.

One’s greatest legacy is likely to be that of how they treated their loved ones. One’s greatest legacy to their loved ones is that they loved them. The dying needs to continue to demonstrate their love even during the process of dying.

Life Review

A review of one’s life helps bring closure at the end of life. Reviewing the highlights of one’s life helps to alleviate regrets by shown the good that emerged from the things one did or didn’t do. The larger picture often shows that things turned out better just the way they did even if the outcome or means held regrets for those who lived them. A proper life review makes whole a person’s life and allows themselves forgiveness for what they did do that was right and proper. Forgiveness releases all the fantasies of what might have been and focuses sharply on what their life is and all the good that surrounds it. A good death is one in which the dying person believes they have done what they were suppose to do. Death then becomes a proper closure to that life. Without regrets, a dying patient can enter death in peace and serenity.

Perception

Perception is more important than reality. People make decisions based on the mental images presented by their perceptions. The better one’s perceptions matches reality, the better chance one has of making the right decisions. One important perception is how to view life and death. “One must stop perceiving death as the loss of a struggle for life, that giving up is a weakness, and instead, to begin to view death as the last of many life passages. If people are lying on their deathbed with remorse, regret, and a willing to die because life has been so hard on them, this is tragedy that is not easily changed at the end of life. If one has not led a good life, then at the end of life, it is too late to change all of that. At this point, the only remaining choice is to achieve a good death. If one pays more attention to how they are living life now, during the fullness of life, they are less likely to end up with burdensome regrets that must be worked off at the time of death. The more one is burdened with regrets from not living a good life, the harder it will be to die a good death.

Preparation

Buddhism holds that it is partly the way in which one prepares for dying that determines enlightenment. Dying well depends on a total consciousness change. Preparing for death includes experiencing visions, alternative life stories, and practicing altered state of consciousness. To be most effective, these preparations must be practiced ahead of the time of death by inducing non-ordinary, ecstatic states similar to those anticipated at death.

To experience a good death, one must experience the severely altered mental state that will emerge at the time of death. They must open themselves up emotionally to reach total acceptance and to embrace death. People have a chance to prepare for death all their lives just by living a good life. In addition, people have an opportunity to walk with death on a regular basis as a reminder on necessity of living the good life now. One can prepare now for death later. Befriend death and you befriend yourself. A good death includes the making of concrete plans for one’s own funeral.[149] Everyone deserves the right to enjoy their own funeral if only in their imagination.

Chapter 15 - Assistance in Dying

In a good death, the dying person wants to be in a familiar, comfortable place surrounded by people who care about them, especially people who understand the special challenges involved in dying. A good death requires specialist in the field of death and dying to facilitate the journey leading to death. Everyone dies by himself or herself, but in a good death, no one dies alone.

Social Network

Miraculously healing and the ‘will to live’ are most often demonstrated in people who have a wide network of people who care about their welfare and love them. In one research, patients with the fewest social contacts had a death rate two and half times higher than those with the highest social contacts. Not only do friends make life more enjoyable when you are healthy, but they serve to help in recovery if you succumb to illness. Should you even become ill, make sure you befriend your health care providers. A doctor who becomes a friend becomes emotionally involved in your recovery. It's the doctor's relationship with the patient that makes a significant difference in recovery. What aids healing is the sharing and caring and doing things for people. Recovery rates soar when the medical staff begins treating patients as if they people and not just a commodity that needs to be fixed and processed according to a medical script.

One caveat, a patient must gain and remain in control of their destiny, their wellness. Don’t ever become so passive that you allow your doctor to make all your life and death decisions for you. It has been observed that people who like their doctor and who are passive about their treatment often die right on schedule as though to prove their doctor’s right.[150]

Support Groups

You tend to like people who are like you, especially those who are in the same predicament as you are. This is why support groups are so valuable to both mental and physical healing. A support group always has something they can contribute to healing of others, even if its only to sit down, talk, and help the patient hope and pray.

In a support group, people talk about all aspect of their lives: treatment, nutrition, exercise, psychological powers, pain management and fear, and techniques for stress reduction.[151] Anytime you find yourself in a situation of a chronic condition of fear, anxiety, and duress, the best action you can take to help yourself is to find others who are suffering from the same afflictions. Collectively, with good group leadership, everyone can gain the value of the talents and perspectives that the individual members bring to the group. Each member of a support group unknowingly teaches the others exactly what they themselves needs to learn in order to be cured of their afflictions. The other members of the support group eventually pick up on this, reframe it from their own perspective, and feed it back to the very member who needs to hear it but in a form that is more palatable. Once the healing message is received by the member who needs it, the insight burns like an irresistible revelation that is adopted immediately and put into effect for the betterment of their life.[152]

One of the most important benefits that any support group offers its members is giving each a reason for living, establishing goals, and keeping the members accountable for working towards them. By building up one’s life force and encouraging the movement towards self-chosen goals, the members of a support group gradually recover and resume normal functioning.

Assistance

Every dying patient needs some trained professional to assist him or her through the process of dying to ensure a good death. After all, most people have no experience with death and dying, especially what it takes to create the conditions for a good death. “A professional medical assistant can help the patient sort through various treatment options and other psychological pathologies that are associated with the overwhelming loss of one's abilities and capabilities to function as a normal human being. Assistance for the dying will focus on helping each dying person take his or her last, and most important journey of a lifetime. An assisted good death not only helps the patient but the entire family as well. There are midwives who are expert in the birthing process, why should there not be a similar function to guide and assist the dying and their families throughout the process of dying. People don't need answers so much as they need someone to listen. People help just by listening and sharing each other’s pain.[153]

The best doctors and care providers are also preachers, teachers, and healers who accept patients as individuals with options to consider and choices to make. Doctors can teach their patients how to live as well as how to die a good death. Empathetic caring is the key for recovery. Studies have shown that when you put a janitor in a psychiatrist's office, the patients will get better as long as the janitor is empathetic.[154]

Assisted Death

There is a distinct difference between Assisted Dying and Assisted Death. The difference lies in the intent and purpose of medical assistance. The intent and purpose of Assisted Dying is to help the terminally ill live as high a quality life as possible until the end when the patient dies according to nature and God’s will. During the time period of dying, the assistant is providing aid, comfort, and guidance to both the patient and their family. On the other hand, the intent and purpose of Assisted Death is to provide the means for a controlled and possibly early death by the application of medications designed to terminate life.

Many people assume that a terminally ill person would prefer to life than to die, so long as there is something to live for and they are not unduly burdened by pain and suffering. If pain, suffering, duress, and intolerable symptoms can not be control with medical means, then an Assisted Death might be an alternative but again only as a last resort.

Other people believe that persons who are guiding the dying should retain Assisted Death as an option so long as there are adequate fail-safe procedures against substandard palliative care and against abuse. The legal profession and judicial rulings have taken a mixed view of the subject of Assisted Death with a preponderance of decisions against it. However, there is a favorable view that condones the over-treatment of pain and symptoms, even if it might lead to an earlier death. Most people agree that the terminally ill have the right a death without undo suffering, and if a medial treatment relieves the pain and suffering, then the treatment is right and proper.

Sometimes the ill person takes matter into their own hands for their own personal reasons, which might include the desire to avoid humiliation and indignity, to avoid financial distress, and/or to preserve the health of the family. Usually, the attending physical has made medications available to treat pain and suffering. The patient and/or caregivers are advised on the threshold of dosage levels that should not be exceeded even in the most vigorous treatment of pain and suffering. Should the patient choose to exceed these dosages to hasten death, the patient must make that decision alone. Just knowing that there is a possibility of an early exit from life from an overdose of pain medication, should the pain and suffering exceed the terminally ill patients ability to withstand it, tends to give one peace of mind during the dying process. Control over one’s destiny greatly relieves anxiety, promoting the ability to endure and continue living for as long as the patient possibly can endure.

Communication

The medical staff must adopt a policy of what information and attitude they will adopt and communicate to their patients whom are either struggling for recovery or for a good death. Any attitude of the medical staff will surely leak to the patient in many a sundry forms despite a good intention to keep it secret. “Once a thought has been thought, it can be communicated to others more effectively. There are hidden channels of communication from the unconscious to our conscious mind.”[155] Once a thought is conceived, it will find a way to manifest itself. Thus, care providers must struggle to stay optimistic and positive themselves, lest these negative attitudes seep out to the detriment of their patients. The best attitude for any one caring for the ill is one of hope and optimism. Any other attitude than hope and optimism will impede healing.

Communication between patients and caretakers is critical to a good death. Doctors have long feared telling a patient the truth and believed that giving someone bad news takes away hope.[156] There are two types of hope that can be communicated to a patient. For those whose prognosis is in doubt, hope and optimism is what the medical care staff need to radiate to the patient. Even for those who are dying and the prognosis is doubtful, hope for a continuity of a quality life worthy of living is still the best way to treat any patient. At the same time, the medical staff needs to reassure the patient that besides hope for life, there is also hope for a good death, however the person who is dying defines it.

Provide the patient with a means for unlimited contact with their loved ones. Place a speakerphone next to the dying patient's bed so that all the relatives can call and bid good wishes as often as they wish, preferably daily.

Families

Families are the first line of defense for both preventing and treating illness and disease. Families provide care giving, emotional support, and most importantly, the reason to get well and live. Families are a stable source of support, but still, care giving and witnessing a loved one undergoing the process of dying is stress producing for the entire family. Dying places an emotional and financial burden on families, especially those who are not prepared for it. While a family usually wants to provide for the care of their loved ones at home, the burden is often just to much. A good solution is an assisted care facility with a team of caregivers who can part of the patient’s extended support group.

Interestingly, strong family bonds and home care bode for a shorter survival time, because the family tends to exercise a lack of discipline in maintaining the strict diets and routines demanded by treatment. The terminally ills family is less well equipped to handle the process of dying unless they get the requisite training, and even better have prior experience with dying.[157]

Having a dying person in the home, and the associated severe emotional strain and financial burden on the family, often participates other crises within the caregivers themselves. To develop a sustainable ability to render care, each family needs to learn how to put boundaries around the illness to preserve their own sanity and well being. Home care, as wonderful as it can be in helping a patient to a good death, is often just too hard for families to endure without assistance. Those families who do find the mental toughness to endure the stress of caring for a dying loved one aren't distinguished by an absence of problems. The hardy families just mobilize and respond with a mental attitude of loving service rather than a focusing on the burden the obligation is causing them. It’s how a family mobilize themselves to confront any problems that arise that counts.[158]

Hospice

One of the best sources for both medical and palliative care giving during the last six months of life is a hospice setting. The cost is reasonable relative to the services rendered. “According to hospice philosophy, death is easier when pain and suffering and other symptoms are well controlled, and when the patient's family and friends can surround them with love throughout the dying process. For patients who quality, a hospice can be a miracle way to receive death. Intimacy with a group of caregivers is made possible in these surroundings. Society in general and the medical profession in particular should incorporate the hospice philosophy into the mainstream of end-of-life medical care.”[159]

Long-term Care

The health care system is not set up to care for those who need expensive, long-term medical care. The medical profession is geared to make sick people well, and death is considered a failure. There is a tendency to continue to throw more medical treatment at a patient in the hopes of affecting a cure. However, medical resources do have a practical limit. Some people worry that in an era of health-care cost containment, it will be more expedient for physicians and families to intimate that it would be expedient for the patient to resign themselves to an early death than to make continued and futile efforts to save them. If the prognosis for dying exceeds six months, the family should consider nursing homes that provide a combination of medial and custodial care. These options would make it easier on both the patient and the family. The patient needs trained caregivers who have the experience in guiding the dying process towards a good death and it also avoids tipping the family into a crisis. Not only are the caregivers trained and experienced professionals, but also the family in not put into a position of rendering care that they have no experience, and in some cases, lack the ability to provide.

Long term care can be paid for out of pocket, by long-term care insurance if one had the foresight to sign up for it ahead of time, or if the patient has no financial resources of their own, a government Medicaid program might provide the financial support.

Chapter 16 - Alternated States of Consciousness

Dying is a time of profound change; in fact, death is the most profound change any living organism can experience. Death is the point of infinite change. In digital code, death is tantamount to a one being flipped to become zero. In the process of dying, the body undergoes continually and progressively decline in capability. The mind and the sense of consciousness undergo extreme changes towards the end. As the body nears exhaustion, and vital organs begin to malfunction, the dying person spends progressively more time resting, sleeping, and seemingly unresponsive to external stimulus. They begin to slip into a dreamlike state and experience untold mental images, trances, visions, and hallucinations. This is the body’s way of disassociating itself with life and the start of melding itself with the mysterious forces on the other side of life.

These periods of altered consciousness are sometimes the source of insightful revelation. If society would only take the time and effort to capture this untapped source of knowledge and insights of pending death, both the human race might be enlightened beyond comprehension. Where else can mankind glean a peak behind the curtain of death and get first hand reports on the merging of a departing soul with the universal consciousness than at the time of death.

Guided Imagery

Palliative care during dying will include activities such as guided imagery that tends to reduce stress, impart comfortable, and render peace of mind. During periods when the dying seem to be entering into a dreamlike state, either as the result of the progression of the disease or induced by the medications to relive the symptoms of the disease, the care givers can aid the patient’s psychic journey with directing their attention to their own breathing and using guided imagery as part of a meditative response. Guided imagery is one tool that can be used to engage and enter into a state of altered consciousness. Hyperventilation breathing, holo-tropic breath work, combined with music, the arts, and expressive movement, can connect the patient with deeply therapeutic states of consciousness.[160] Experienced professionals are best used in these matters, but there is no reason why an untrained layperson or family members might not try to render these kinds of services so long as the patient finds the experience positive.

Consciousness

Consciousness is the last normal vestige of life to leave a person as they lapse into death. Before death, one tends to slip into an extreme state of supernormal consciousness from which they never awaken. Medically, brain functions cease and measurable brain wave signal cease. At this point, a physician would declare the patient as dead. But what happens after this point, no one knows for sure. The state of super-consciousness is difficult to measure. There have been some people who have returned from what seems like a Near-Death Experience (NDE) to report what they experienced during this episode when they were medically declared dead. Most of these reports are similar and include a sense of bliss/euphoria, peaceful serenity, complete acceptance and love, meeting someone ready to take them to an unknown destination, unimaginable brilliant lights and colors, and a sense of rapid motion as in a tunnel. Some NDE reports include a lingering at the place of death and being able to see one’s former body and those in attendance fussing over their former body, all witnessed by looking down from above. Perhaps at the end of life, both life and death converge to the least common denominator, which is cosmic consciousness.[161]

Music

Music can ease the transition to death. Music can be selected to the right synchronization to calm a person's breathing and state of consciousness. Music helps soothe a patient’s mind and helps the soul to leave the body. There is different music that is fitting for life and for death.[162]

Music can also aid the dying to enter a blissful unconsciousness and dreamlike state wherein they can begin connecting with the universal consciousness as a precursor death. These dreamlike states progressively and incrementally expose and acclimate the dying ease into death when it comes.

Singing

Similar to music and other guided imagery techniques, singing can also aid the dying in entering blissful unconsciousness and a dreamlike state where they can begin connecting with the universal consciousness. Nothing creates greater positive energy faster than singing. [163]

Chapter 17 - Spirituality

If there is an after life, it would have to be spiritual in nature, as the one thing we do know about death is that the deceased leaves their body behind when they leave and the living bury it. If there is such a thing as miraculous cures, it will have to come from the realm we know little about such as our higher consciousness and spirituality. So, when all else fails, this is where one turns for miracles.

Spirituality

“There is a spiritual dimension to dying. Even during the period of dying, spiritual growth of our soul can continue in the midst of sadness of loss. We are not just our bodies. Who we really are is spirit, which moves to a different plane when we die. The spirit expands exponentially as the patient nears death.[164] Whatever bodily functions one loses to disease and illness, the critically ill can gain so much more from an extension into the spiritual realm. To get the most from the spiritual dimension, one must rely upon the trained professions of their religion.

When we summon our higher consciousness and spirituality, we connect to an even higher, universal consciousness and spirituality. “Every problem, even illness, brings with it the possibility of a widening consciousness.”[165] Our higher consciousness and expanded spirituality are the source of a higher quality of life, but we must climb to reach these elevations. Even though quality of life is the most important thing, people naturally want to extend its quantity too.[166] Fortunately, the people who are most content with their life, tend to live longer.

If a patient fervently believes in religious healing, through the laying on of hands for example, the physician must not be an obstacle and detract from that treatment's effectiveness.[167] As it was previously suggested, the Placebo Effect will leverage any treatment if the patients believe the healer who is administering it. Any belief, no matter how strange or unlikely, are likely to help in the patient’s recovery, if the patient believes in them and brings their higher consciousness into play as a resource of that belief. Anything that can be done to engage a patient’s belief in their treatment plan can only make the treatment more effective. Whatever other factors the patient can be led to believe is aiding their cure, it should be encouraged in addition to standard medical treatment. Spirituality is a dimension of healing that has the almost unlimited power to inspire miracles. Spirituality is a belief that there is some meaning and created order in the universe which allows one to find fulfillment, peace and happiness, even in an imperfect world.[168]

Some people believe that most illnesses are due to problems of the spirit rather than a breakdown of the body. A spiritual healer must not allow the patient to believe that their illness is in any way a punishment for the patient’s transgression against God.[169] Instead, the patient must be advised that it is God’s will that his children thrive and prosper. So, if an illness plagues a patient, then it is due not to God's will, but it is due to a deviation of our life style from God's grand design for how life should be lived. Changes in one’s spirituality and life style are often effective remedies to diseases, especially those that are self-induced by erroneously beliefs.

Religion

The chief purpose of religion is to help connect people to their creator and to the life the creator wants the created to live. Supposedly, if we live according to the intentions of our creator, not only will we enjoy a good life but be rewarded in the next life as well. Thus, a natural resource for a good death is the religious community to which one subscribes.

If one were ever to follow the prescripts of their faith and draw comfort from their chosen religion, during the occasion of their dying might be one the better time to do so. Living one’s faith during the process of dying will give them the peaceful resolve to enter into a good death. “The chief purpose of all religious texts and rituals was to help people consummate a life well lived with a death that was transcendent into the next realm.”[170]

Miracle Cures

When one believes in love and miracles, conditions for divine intervention are created and invite unbelievable cures. Belief moves us in the direction of possibilities and miracles, so long as we take the actions that will bring them about. “Most people want God to fix everything for them so they can go on living as they have. People want to be exempt from the responsibility of their wellness. It is easier to play the victim role and suffer than it is to engage in the life changing work of love, forgiveness, acceptance, & finding peace.”[171] Unfortunately, miracles don’t work this way. Miracles happen when both God and the patient each play their role required of healing. More than anything, the patient has to want wellness more than they want the illness.

“Acceptance, faith, forgiveness, peace, and love are the traits of spirituality. These characteristics are always found in those who achieve miracle cures. Miracles come from finding your authentic self and following what you feel is your own true course in life.”[172]

Medical science is moving swiftly. One generation's miracles may be another's scientific fact. Do not close your eyes to acts or events that are not always measurable. Miracles happen by a mysterious inner energy or life force available to all of us which one might call a self-induced healing. Miracles also come from God's interventions and should be used along with our own inner healing powers.[173]

Miracles come from within as well as without. When you hold yourself in high esteem and love, you place the will to live within yourself. You may have shortcomings and have much that needs to be forgiven, but if you still belief in yourself, you can create miracles. You can't change your perceived shortcomings until you accept yourself despite them.[174] Many miracles are nothing more than coming to grips and accepting who your are, what you’ve done, and where you are going in life. And if you don’t find what pleases you, so long as you are alive, you can change everything.

Chapter 18 - Transcendence & Beyond

Where does the deceased person’s essence go after their bodies expire? No one knows the answer to this question. Most people believe that a person’s soul or spirit reaches transcendence into another realm in the after life. Whether this is true or not, the belief in the prospect of an existence-after-death makes dying easier. For people who believe in life after death, death is not so much a loss as it is a rebirth into a new dimension. Life is not lost but simply transformed into something better than life.

To heal, people must not deny their physical limits but rather to transcend them.

Growth

“Life can blossom in new ways as the dying person nears death. One can continue growing in both mind and spirit, even as the end of life grows nearer, by many means. One such growth enhancing activities is to reframe and reinterpret one’s total life by putting it into a different context. Care givers can aid this process with activities wherein the dying tap into their memories and life stories, making them aware of having had a past, a present, and a future.”[175]

The dying should not be left alone in a bed from which they are ultimately unable to leave by themselves with nothing to do except to entertain themselves. People can grow in spirit and readiness to transcend to the next life if they are properly guided. Patients who are still lucid can be wheeled into meeting rooms and the presence of others who are dying and unit themselves in a common cause of raising their spiritual growth.

Learning

“Dying well is an art that can be learned, an art essential to a good passage into the next life.”[176] Both the terminally ill patient, their families need assistance in the dying process. The more people know what to expect about the dying process, the less surprised and more accepting they become. In death, as in any other adventure, expectations need to be managed so that false assumptions do not lead to bad endings.

Near Death Experiences

Reports from people who have experienced Near Death Experiences are eerily consistent. “Near Death Experiences repeatedly confirm the presence of light, life review, euphoria, and the merging of consciousness with the universal consciousness. People who experience NDE tell afterwards is that life is about unconditional love.”[177] There is disagreement among the experts as to whether the NDE is anything more than a common physiological response by the brain when a vital organ shuts down its supply vital nutrients to keep the brain functioning normally. Regardless, death is unusually pronounced when brain activity ceases. During the short time it takes for brain activity to cease completely is exactly when the Near Death Experiences begin. As the dying person’s brain begins to cease its functioning, the person undergoing death has an experience with the life beyond. These NDEs, as reported by those who were successfully revived, tell us what the act of dying is like, and from all reports, dying is a euphoric experience. This information fits perfectly with what we have been led to believe by our religious community…there is life after death and it is a glorious existence.

After Deaths Signs of Life

At the time of death, people have a need for a transcendent dimension, a need to connect with something larger than themselves.[178] Not only does a belief in life-after-death give one the courage to die but a mysterious adventure to look forward to.

There have been reports of signs of activity after death. There are confirmed reports from family and friends about the dead leaving a prearrange sign that they have successfully transcended and that there is a form of life after death. In these reports, witnesses arranged with the dying some manner by which they would send a prearranged signal. Many people have been disappointed in such rearrangements, but some people report incidents where the signal was received just as it has been prearranged. One such report involved a signal based on the slight skewness of a favorite picture hanging on the wall. Whether the dead have the power to leave a sign is unknown, and if they could, there would likely be considerably more signs left and received. However, the reports of after-death signs are rare, perhaps because so few arrangements are made in advance or perhaps because such a power by the dead is not a part of the celestial plan. Still, it does no harm to make arrangements with the dying to make the effort.

Visions

“Hallucinations can be expected at the end of life, and other deathbed visions. Delirium is hard to reverse, mainly because dying is hard to reverse. Many peak experiences occur near death as endorphins are released.”[179] Deathbed visions include all manner of descriptions that the dying reports as they near the end of life. The living would be well advised to collect this information because this may be the only feedback devise between the living and the dead.

Dying can be aided by guided imagery to ease the passage. As death nears, caregivers should tell the dying to go towards the light and to look for relatives and friends. Near death experiences reported at death's door include the following: 1) joyous reunions with dead, 2) speeding over long distances inside dark tunnel, 3) high speed review of life, 4) intensely brilliant, warm, and loving light, 5) and overwhelming sense of release and peace.

When the image of death comes during mediation, a powerful dream state, hallucination, or vision, the dying person should be directed to practice moving towards the most powerful energy. Hence, the value of meditation, guided imagery, and self-hypnosis/auto-suggestion as a way to rehearse dying and to receive renew inspiration for living. The closer the dying approaches death, the easier it is to see the unimaginable mysteries that lie at the edge of life that we normally can't see.

Anytime the people attending to the dying can report these experiences, the more information that can be aggregated, studied about the process of death, and captured about the mystery that surrounds death.

Chapter 19 - Conclusions to a Will to Live

Death need not be feared just because we don’t know what comes after it. However, the promise of good death coming at the conclusion of a good life eases the fear and burden of death. If there is anything to fear about death, it is realizing that one has not really lived a good life. People with a will to live don’t seem to have this problem. Not only do they enjoy a higher quality of life, but also they live it longer and in better health. If people with a survivor’s mentality get ill, they treat illness as just another challenge that needs to be overcome and conquered. They tend to provide their own miracle cures.

One should not become overly concerned with death so long as they are living the life they love. When death becomes inevitable, by then, people with a reason to live and hence a will to live will still be striving to live a good life even with old age and infirmities. They just don’t have time to die; they are so busily engaged in playing out their roles that life imbues them with the energy to keep going on and on.

When it does come time to die, there is only one way to go…with a good death. A good death is one with dignity, closure (few lose ends), no regrets, without pain and suffering, and with loved ones close at hand. Those who have lived a good life do not fear death. They accept the inevitable, but still try to push it out as far as possible from wherever they are in their life. They take on the prospect of death like any other challenge with its own set of opportunities. For who knows, death might be just as much a new beginning as it surely is an end. Just as birth was surely a new beginning, birth might have been preceded by the termination of some other form of existence. We don’t know, but just as we celebrate life, so should we celebrate death and the completion of a good life.

A good death is just as important as a good life. If one plans for a good death, they are likely to experience one. There is a prescription for attaining a good death, and if followed, it will lead to one. The ideas suggested in this handbook, if aggregated into a concerted plan of action or followed, then surely the results will not only support a good life but a good death as well.

[1] Marilyn Webb, The Good Death

[2] Marilyn Webb, The Good Death

[3] Marilyn Webb, The Good Death

[4] Marilyn Webb, The Good Death

[5] Marilyn Webb, The Good Death

[6] Marilyn Webb, The Good Death

[7] Marilyn Webb, The Good Death

[8] Marilyn Webb, The Good Death

[9] Marilyn Webb, The Good Death

[10] Albert Camus

[11] Bernie Siegel, Love, Medicine, and Miracles

[12] Bernie Siegel, Love, Medicine, and Miracles

[13] Bernie Siegel, Love, Medicine, and Miracles

[14] Bernie Siegel, Love, Medicine, and Miracles

[15] Bernie Siegel, Love, Medicine, and Miracles

[16] Marilyn Webb, The Good Death

[17] Bernie Siegel, Love, Medicine, and Miracles

[18] Elida Evans, Psychological Studies of Cancer

[19] Bernie Siegel, Love, Medicine, and Miracles

[20] Bernie Siegel, Love, Medicine, and Miracles

[21] Bernie Siegel, Love, Medicine, and Miracles

[22] Bernie Siegel, Love, Medicine, and Miracles

[23] Bernie Siegel, Love, Medicine, and Miracles

[24] Bernie Siegel, Love, Medicine, and Miracles

[25] Bernie Siegel, Love, Medicine, and Miracles

[26] Bernie Siegel, Love, Medicine, and Miracles

[27] Bernie Siegel, Love, Medicine, and Miracles

[28] Bernie Siegel, Love, Medicine, and Miracles

[29] Bernie Siegel, Love, Medicine, and Miracles

[30] Bernie Siegel, Love, Medicine, and Miracles

[31] Bernie Siegel, Love, Medicine, and Miracles

[32] Bernie Siegel, Love, Medicine, and Miracles

[33] Bernie Siegel, Love, Medicine, and Miracles

[34] Bernie Siegel, Love, Medicine, and Miracles

[35] Bernie Siegel, Love, Medicine, and Miracles

[36] Bernie Siegel, Love, Medicine, and Miracles

[37] Bernie Siegel, Love, Medicine, and Miracles

[38] Bernie Siegel, Love, Medicine, and Miracles

[39] Bernie Siegel, Love, Medicine, and Miracles

[40] Bernie Siegel, Love, Medicine, and Miracles

[41] Bernie Siegel, Love, Medicine, and Miracles

[42] Bernie Siegel, Love, Medicine, and Miracles

[43] Bernie Siegel, Love, Medicine, and Miracles

[44] Bernie Siegel, Love, Medicine, and Miracles

[45] Bernie Siegel, Love, Medicine, and Miracles

[46] Bernie Siegel, Love, Medicine, and Miracles

[47] Bernie Siegel, Love, Medicine, and Miracles

[48] Marilyn Webb, The Good Death

[49] Bernie Siegel, Love, Medicine, and Miracles

[50] Bernie Siegel, Love, Medicine, and Miracles

[51] Bernie Siegel, Love, Medicine, and Miracles

[52] Bernie Siegel, Love, Medicine, and Miracles

[53] Bernie Siegel, Love, Medicine, and Miracles

[54] Bernie Siegel, Love, Medicine, and Miracles

[55] Bernie Siegel, Love, Medicine, and Miracles

[56] Bernie Siegel, Love, Medicine, and Miracles

[57] Bernie Siegel, Love, Medicine, and Miracles

[58] Ellerbroek, in Bernie Siegel’s book, Love, Medicine, and Miracles

[59] Bernie Siegel, Love, Medicine, and Miracles

[60] Bernie Siegel, Love, Medicine, and Miracles

[61] Bernie Siegel, Love, Medicine, and Miracles

[62] Richard Bach, Jonathan Livingston Seagull

[63] Christian Frederick Hebbel

[64] Viktor Frankl

[65] Elizabeth Kuber-Ross

[66] Bernie Siegel, Love, Medicine, and Miracles

[67] Russell A. Lockhart

[68] Bernie Siegel, Love, Medicine, and Miracles

[69] Bernie Siegel, Love, Medicine, and Miracles

[70] Bernie Siegel, Love, Medicine, and Miracles

[71] Bernie Siegel, Love, Medicine, and Miracles

[72] Bernie Siegel, Love, Medicine, and Miracles

[73] Arnold Hutschnecker, The Will to Live

[74] Bernie Siegel, Love, Medicine, and Miracles

[75] Bernie Siegel, Love, Medicine, and Miracles

[76] Marilyn Webb, The Good Death

[77] Marilyn Webb, The Good Death

[78] Marilyn Webb, The Good Death

[79] Marilyn Webb, The Good Death

[80] Marilyn Webb, The Good Death

[81] Marilyn Webb, The Good Death

[82] Marilyn Webb, The Good Death

[83] Marilyn Webb, The Good Death

[84] Bernie Siegel, Love, Medicine, and Miracles

[85] Bernie Siegel, Love, Medicine, and Miracles

[86] Bernie Siegel, Love, Medicine, and Miracles

[87] Bernie Siegel, Love, Medicine, and Miracles

[88] Bernie Siegel, Love, Medicine, and Miracles

[89] Marilyn Webb, The Good Death

[90] Marilyn Webb, The Good Death

[91] Marilyn Webb, The Good Death

[92] Marilyn Webb, The Good Death

[93] Marilyn Webb, The Good Death

[94] Williams C. Williams

[95] Chief Justices Brennan, Marshall, and Blackmun

[96] Marilyn Webb, The Good Death

[97] Marilyn Webb, The Good Death

[98] Marilyn Webb, The Good Death

[99] Bernie Siegel, Love, Medicine, and Miracles

[100] Marilyn Webb, The Good Death

[101] Marilyn Webb, The Good Death

[102] Marilyn Webb, The Good Death

[103] Marilyn Webb, The Good Death

[104] Marilyn Webb, The Good Death

[105] Diane Haug

[106] Marilyn Webb, The Good Death

[107] Bernie Siegel, Love, Medicine, and Miracles

[108] Bernie Siegel, Love, Medicine, and Miracles

[109] Bernie Siegel, Love, Medicine, and Miracles

[110] Marilyn Webb, The Good Death

[111] Marilyn Webb, The Good Death

[112] Marilyn Webb, The Good Death

[113] Marilyn Webb, The Good Death

[114] Marilyn Webb, The Good Death

[115] Ram Doss

[116] Elisabeth Kubler-Ross

[117] Marilyn Webb, The Good Death

[118] Bernie Siegel, Love, Medicine, and Miracles

[119] Marilyn Webb, The Good Death

[120] Marilyn Webb, The Good Death

[121] Marilyn Webb, The Good Death

[122] Judy Kelterborn

[123] Bernie Siegel, Love, Medicine, and Miracles

[124] Marilyn Webb, The Good Death

[125] Bernie Siegel, Love, Medicine, and Miracles

[126] Bernie Siegel, Love, Medicine, and Miracles

[127] Bernie Siegel, Love, Medicine, and Miracles

[128] Bernie Siegel, Love, Medicine, and Miracles

[129] Bernie Siegel, Love, Medicine, and Miracles

[130] Bernie Siegel, Love, Medicine, and Miracles

[131] Bernie Siegel, Love, Medicine, and Miracles

[132] Bernie Siegel, Love, Medicine, and Miracles

[133] Bernie Siegel, Love, Medicine, and Miracles

[134] Dr. Kennish

[135] Marilyn Webb, The Good Death

[136] Marilyn Webb, The Good Death

[137] Marilyn Webb, The Good Death

[138] Judge Stephen Reinhardt

[139] Bernie Siegel, Love, Medicine, and Miracles

[140] Bernie Siegel, Love, Medicine, and Miracles

[141] Bernie Siegel, Love, Medicine, and Miracles

[142] Bernie Siegel, Love, Medicine, and Miracles

[143] Bernie Siegel, Love, Medicine, and Miracles

[144] Bernie Siegel, Love, Medicine, and Miracles

[145] Bernie Siegel, Love, Medicine, and Miracles

[146] Marilyn Webb, The Good Death

[147] Marilyn Webb, The Good Death

[148] Marilyn Webb, The Good Death

[149] Ma Jaya Bhagavati

[150] Bernie Siegel, Love, Medicine, and Miracles

[151] Bernie Siegel, Love, Medicine, and Miracles

[152] Bernie Siegel, Love, Medicine, and Miracles

[153] Marilyn Webb, The Good Death

[154] Bernie Siegel, Love, Medicine, and Miracles

[155] Bernie Siegel, Love, Medicine, and Miracles

[156] Marilyn Webb, The Good Death

[157] Marilyn Webb, The Good Death

[158] Marilyn Webb, The Good Death

[159] Marilyn Webb, The Good Death

[160] Marilyn Webb, The Good Death

[161] Marilyn Webb, The Good Death

[162] Marilyn Webb, The Good Death

[163] Elisabeth Kubler-Ross

[164] Elisabeth Kubler-Ross

[165] Jung

[166] Bernie Siegel, Love, Medicine, and Miracles

[167] Bernie Siegel, Love, Medicine, and Miracles

[168] Bernie Siegel, Love, Medicine, and Miracles

[169] Bernie Siegel, Love, Medicine, and Miracles

[170] Marilyn Webb, The Good Death

[171] Bernie Siegel, Love, Medicine, and Miracles

[172] Bernie Siegel

[173] Bernie Siegel

[174] Bernie Siegel

[175] Marilyn Webb, The Good Death

[176] Marilyn Webb, The Good Death

[177] Marilyn Webb, The Good Death

[178] Dr. Mount

[179] Marilyn Webb, The Good Death

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