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What the Media Said about End-of-Life Care This Week
Week of
July 25, 2005
…a
service of
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NEW BOOK EXPLORES POWER
OF DREAMS NEAR LIFE’S END
A Newsweek
article entitled “A Dream Before Dying” shares
about the power of dreams for people close to death. In Dreaming Beyond
Death, Chaplain Patricia Bulkley says that many
dying persons have extraordinary dreams in their last days and weeks, but “all
too often, caregivers dismiss them as delusional or unworthy of attention.” Bulkley discussed
dreams with patients at
Though
stories and tales of “meaningful pre-death dreams” have existed from ancient
times in many religions and cultures, little systematic study has been done of
them. The article cites obvious
problems – the inability to enroll dying people in formal studies comes
immediately to mind. The percentage
of people experiencing such dreams is unknown, but scientists do recognize that
the dreams can have deep meaning.
Certain themes recur – journeys, reunions with deceased loved ones, stopped clocks and lights. One woman dreamed of a candle in her hospital window that is snuffed out and then spontaneously relights outside her window. One man decided that “somehow, we all belong to one another” after finding meaning in dreams of a square dance where partners left visible traces of movements.
But some of the dreams are very frightening, such as being caught up in tornadoes or riding in a driverless car. Rosalind Cartwright, Rush University Medical Center chair of behavioral sciences, says that these are dreams of unresolved issues. Scary as they are, they may ultimately help the dreamer find peace, Cartwright asserts, by forcing the dreamer’s attention to underlying problems.
These
pre-death dreams are also “more urgent, more vivid and more memorable than the
run-of-the-mill patchwork of dreams.
That’s not surprising, says Alan Siegel, psychologist at the
Still, Bulkley says, caregivers often don’t explore the meaning with dying persons, which is a loss on both sides. Discussing the dreams with family is a way to bring up the topic of death. Just talking about the dream offers a “simple way to articulate complex emotions – or, if the meaning of the dream is unclear, to fathom its purpose.” And when the dying person is comforted by the dreams, according to Bulkley, so is the family. “These are the stories that get repeated at funerals,” she says. “They become part of the family lore.”
Bulkley and Bulkeley “resist the notion that pre-death dreams prove the existence of God.” But dying persons often see them as “affirmations of faith.” One of Bulkley’s patients doubted the nature of God. She dreamed, three nights in a row, of “huge boulders that pulsated with an eerie blue light.” For her, they represented an unidentified divine being, one that was very real to her. She told Bulkley, “I don’t need to know anything more than that. God is God.” But in her final dream, the boulders turned into steppingstones and a golden light glowed in the distance. “It’s calling me now,” she said, “and I want to go.” The next day she died, at peace. (Newsweek, 7/25)
PAIN NOTES
* Researchers
at
* The Partners for Understanding Pain coalition is inviting pain management advocates to join them in visits to Congress on September 14. They will be encouraging Congress to support the National Pain Care Policy Act of 2005 (HB 1020). A guide for preparation for the Congressional visits is at www.theacpa.org. (American Chronic Pain Association Website)
*
* The
spring issue of Practical Bioethics, a quarterly publication of the
Center for Practical Bioethics in
* Though it has yet to file any charges against him, the DEA has seized 72 patient charts from neurologist Richard Nelson and confiscated his “drug-dispensing permit.” Nelson, who lives in Billings, Montana, specializes in pain management, has spent $20,000 on lawyers and says, “My practice is sunk.” The article says that, over the past six years, more than 5,600 physicians across the nation have been investigated, because they were suspected of “drug diversion” and more than 450 have been prosecuted. One doctor who is closing his practice to new pain patients said, “It is impossible to be sure that a patient is not diverting any of his medication.” (Time Magazine, 7/25)
* The recently released National Women’s Health Report, “Pain & Women’s Health,” warns “that the under-treatment of chronic pain in women is a severe problem in our society and leads to lack of productivity and a reduced quality of life.” The report contains articles on COX-2 inhibitors, major depression in chronic pain sufferers, migraine headaches and pain management in older adults. See www.healthywomen.org for a free copy of the report. (PR Newswire, 7/20)
* The New York Times Op-Ed Columnist,
John Tierney, says the DEA and local police departments did their level best
during the drug wars of the 1980’s and 1990’s, only to see cheaper, purer drugs
hit the streets in greater quantities than ever. So, under pressure from Congress for results,
they “defined deviancy up.” Going after
doctors had several advantages over going after crack dealers – they were
in the phone book, unarmed, kept office hours and records of prescriptions and
had assets that could be seized by the police.
Getting treated for pain has become much more difficult, but the
White House’s drug policy agency reported progress after a field survey on drug
use in
OTHER NOTES
* Oregon Congressional Democrats, Senator
Ron Wyden and four Representatives, held a press conference on July 20,
announcing that the group had filed a brief with the US Supreme Court reminding
the court that questions of assisted suicide are a matter for the states, not
the federal government. A second
purpose of the brief was to “reinforce the fact that the Controlled Substances
Act is designed to pursue drug dealers and people involved in criminal
activity.” The leaders fear that actions
by the Bush administration “will have a chilling effect on pain management, not
just in
* Francesca
Hartman, the
* “Medicare and Chronic Conditions,” in the current NEJM, asserts that the original orientation of Medicare toward the “treatment of acute, episodic illness” will have to change if “the Medicare program is to be truly responsible to its millions of beneficiaries who have chronic conditions, especially those with multiple coexisting illnesses.” Saying that Medicare cannot do this alone, the authors call for changing “the delivery system, the research infrastructure, clinical education, and methods of financing medical care in order for the health care system to become more responsive to the needs of people with chronic conditions.” (NEJM, 2005;353:305-309)
* ICE is
“gaining momentum on both sides of the