Facebook Users Can Add Organ Donor Status
Hayley Tsukayama, The Washington Post (May 01, 2012)
Facebook has added a unique feature to its social network: you can now tell the world — or just your family members — that you’re an organ donor.

Facebook in Organ Donation Push
James Gallagher, BBC News (May 01, 2012)
Three people die every day while waiting for a transplant, NHS says. NHS
Blood and Transplant said the partnership was an “exciting new way” to
encourage donation. Around 10000 people in the UK are on the waiting list
for an organ.

A quick post on a story from yesterday’s news that we at the Death Reference Desk expect many people caught. Facebook, and more specifically Mark Zuckerberg, announced that FB users can now use their Facebook accounts to register as Organ Donors. Here is how it works:

1.) Go to your account and click on Life Event
2.) Click on Health & Wellness
3.) Click on Organ Donor and then enter whatever information you want about being a donor.

If you are in the United Kingdom and want to be an organ, tissue, and/or bone donor but are not yet on the NHS Donor Registry then the UK version of FB enables you to sign up.

I’m a registered organ donor in both America (on my Great State of Wisconsin drivers license) and the UK via the donor registry. I am also now an official Facebook organ donor(!) so you know it’s for real.

Two things to say about this move by Facebook. First off, it’s a good idea. The more that people discuss end of life decisions, such as organ donation, before a person is hooked up to a ventilator and unable to communicate is always helpful. Indeed, this new FB Life Event option is being trumpeted as a way for individuals to unequivocally demonstrate their commitment to postmortem organ donation. This is important so that next-of-kin do not block the use of said organs when the time comes for a decision.

Here is my second take. By making this move, Facebook is entering into a world of longer sustainability. For all of FB’s novelty (and sometimes silliness) this organ donation option means that users can now begin managing their end of life planning through Facebook. This is key. Countless other interweb companies have sprung up to manage these end of life issues, especially for deceased FB users, and Death Ref has covered those companies here. Yet Facebook itself hasn’t really ventured into the reality of death, or that its users die.

I fully expect that Facebook central will eventually add a funeral planning option for its account holders. Down the road.

And by attaching a person’s future/inevitable death to a Facebook account Mark Zuckerberg might just create that one internet app that everyone will want in order to plan a funeral.

Thus demonstrating Death Ref’s Rule #1 for any user based technology: Everybody eventually dies.

Including Facebook users.

The Afterlife of Artificial Hips and Knees
Clark Boyd and Rob Hugh-Jones
PRI’s The World via BBC News (February 21, 2012)
The metal used in surgical implants can be melted down and recycled after people are cremated, and these days it often is.

Long time readers of the Death Reference Desk might remember this August 2009(!) post: Reduce – Reuse – Recycle – the Dead… I mention this particular post because the BBC News and PRI’s The World radio programme just did a piece on a Dutch company that recycles metal implants used in humans.

Here’s the rub: the metal implants are recycled after an individual is cremated.

In all honesty, there isn’t much new about this technology but since the process involves dead bodies it is always fascinating.

Indeed, if you would like a full rundown on everything Eco-Death then click away. We’ve been covering this topic since Death Ref took its first humble steps.

Here is the lead from the BBC News article:

As people live longer and medical technology improves, more and more of us will have a surgical implant before we die. We are also getting cremated in larger numbers – and so there is often some expensive metal left among the ashes. Where does it go?

“You tell people what you do, and they think… well, that’s a bit strange,” says Ruud Verberne above the din of giant sorting machines twirling and clanking.

Verberne is co-founder of OrthoMetals, which recycles metal implants from cremated human bodies. That’s everything from steel pins to titanium hips and cobalt-chrome knees.

These are the knees that we have to recover,” he says. “Some metals can be sorted by magnets. And the remaining have to be sorted by hand.”

Strange it may be, and a bit macabre perhaps, but this kind of recycling is a growth industry.

“I know the existence of five or six competitors that we have, most of them in the United States,” says Verberne, whose company is based in the Dutch city of Zwolle. “But we were first.”

There isn’t a ton of money to be made in postmortem-human-implant-metal-recycling but that is probably ok.

And who knows where the implant metal recycling market will lead. I am keeping my eye on a Detroit, MI company, Implant Recycling, in the hopes that one day Motor City will rise again by cornering the market.

That particular Renaissance would be only too fitting.

Under Recent Policy, Cook County Begins Donating Unclaimed Bodies after 2 Weeks
Cadavers that are left in morgue are given to medical research
Becky Schlikerman, William Lee and Ronnie Reese, Chicago Tribune (October 04, 2011)

Medical Examiner: Families Who Object to Body Donation Can Opt for Burial
Becky Schlikerman, Chicago Tribune (October 05, 2011)

There was a bit of a dead body tug-of-war this week in Chicago. According to an October 4 article in the Chicago Tribune, any dead body left unclaimed for two weeks in the Medical Examiner’s office will be handed over to the Illinois Anatomical Gift Association.

But wait, that’s not totally true.

According to an October 5 article in the Chicago Tribune, the Medical Examiner’s office will not donate any unclaimed body to the Anatomical Gift Association when the ME’s office knows that the next-of-kin cannot afford to have the dead body claimed and the next-of-kin want a burial.

Here is the bigger issue in this story: the overall costs for retrieving a body from a Medical Examiner’s office have become too expensive for many families.

We started covering this situation in 2009, when the Death Reference Desk launched. You can look over all those previous posts in the Death + the Economy section.

More and more county morgues across America are dealing with not only unclaimed dead bodies, but unclaimed dead bodies and families who know exactly where said dead body is located but can’t afford to do anything about it.

As a result, the Cook County story is hardly surprising.

Given the economic difficulties more and more American families face, this story represents not an anomaly but the future.

For more on Medical Examiners and their work, watch the fantastic Frontline documentary Post Mortem: Death Investigation in America

Death and Budgets
David Brooks, New York Times (July 15, 2011)
Much of the budget mess may stem from a deep cultural antipathy toward recognizing our own mortality.

The Quagmire: How American Medicine is Destroying Itself
Daniel Callahan and Sherwin B. Nuland, The New Republic (July 15, 2011)

Since the American political system (read: mostly the Republican party) seems hell bent on watching the federal government go into default I though that I would revisit a recent column by David Brooks in the New York Times. Earlier in July, Brooks wrote about spending on End-of-Life care and Medicare. For those who don’t understand the idiosyncrasies of the American health care system, Medicare is the medical insurance all US citizens receive at age 65. It’s a good program. Both my parents use it.

One of the financial issues that Medicare faces is that more and more people are living to be older than before. Well into their 80s. The extension of age, by itself, isn’t an issue. Where the problems begin are with medical costs soaring in the last few months of life.

The second article at the top, by Daniel Callahan and Sherwin B. Nuland (which Brooks references), explains the costs this way:

In a 2006 article, Harvard economist David Cutler and colleagues wrote, “Analyses focused on spending and on the increase in life expectancy beginning at 65 years of age showed that the incremental cost of an additional year of life rose from $46,800 in the 1970s to $145,000 in the 1990s. … If this trend continues in the elderly, the cost-effectiveness of medical care will continue to decrease at older ages.” Emory professor Kenneth Thorpe and colleagues, summing up some Medicare data, note that “more than half of beneficiaries are treated for five or more chronic conditions each year.” Among the elderly, the struggle against disease has begun to look like the trench warfare of World War I: little real progress in taking enemy territory but enormous economic and human cost in trying to do so.

One of the most important ways to address these cost issues is by talking about death and dying. The crux of David Brooks article is that:

…we think the budget mess is a squabble between partisans in Washington. But in large measure it’s about our inability to face death and our willingness as a nation to spend whatever it takes to push it just slightly over the horizon.

I agree. Callahan and Nuland also make a similar argument. Indeed, the Death Reference Desk ran a piece in August 2009 on exactly this issue: America and End-of-Life Care: Death, Dying, and Mortality.

In fact, most of the death with dignity posts on Death Ref deal with the question of death acceptance in one way or another.

So, what’s to be done. Until the US budget issues are sorted, not much. The first step, which isn’t easy by any means, is telling people that death is ok. Especially at the end of life, when compassionate care will go a long ways towards extending quality of life instead of fixating on the quantity of days.

Callahan and Nulland make a quick reference to the “…war against death” in their essay.

They are absolutely correct. A war is being fought against death, particularly in America.

And we modern humans will lose that war. Every single time.

Terry Pratchett: Choosing to Die
BBC iPlayer (only available until 9:59PM Monday, June 20, 2011)

Terry Pratchett’s BBC Documentary Reopens Debate on Assisted Dying
Fantasy writer’s film shows final moments of a man with motor neurone disease at Dignitas clinic in Switzerland
Esther Addley, The Guardian (June 07, 2011)

Terry Pratchett Defends Choosing to Die Documentary from Critics
Critics round on writer and BBC for promoting assisted dying in film that included footage of man’s death at Dignitas clinic
Haroon Siddique, The Guardian (June 14, 2011)

TV Review: Terry Pratchett: Choosing to Die
When life is finally squeezed of all its juice, Terry Pratchett finds there’s tea on tap
Sam Wollaston, The Guardian (June 13, 2011)

I cried and cried towards the end of Terry Pratchett’s documentary on Assisted Dying. My tears arrived not at the end of the documentary, where Pratchett watches UK citizen Peter Smedley die in Switzerland at the Dignitas Clinic. Rather, I began to cry when the various individuals involved in this documentary started traveling to Switzerland. I can only explain my emotional response as tears of respect for Peter Smedley and his wife as he chose death over a physical life increasingly controlled by motor neurone disease.

The documentary, Terry Pratchett: Choosing to Die, was shown on BBC 2 Monday night and it created a week’s worth of commentary. Most of it predictably either for or against everything in the documentary.

I do not know what to say any longer about the UK’s debate on Assisted Dying. Indeed, the Death Reference Desk has a number of pieces on Assisted Dying debates in both the UK and the United States. You can review all of those previous posts here. It’s worth noting, I think, that when Death Ref started in July 2009 some of the first posts were on the UK’s Assisted Dying debates.

Some pieces of that debate have changed but not significantly. The only anti-Assisted Dying argument that I will flag up as incorrect is the assertion that the deaths which people choose somehow diminish the value of hospice care. That is not true. Many many people choose hospice care at the End-of-Life and I wholeheartedly support that choice. But hospice care and End-of-Life care are different than choosing an Assisted Death. These things are related but they are not co-terminus. Advocates for both hospice care and assisted death often find themselves in televised debates but these same individuals are involved in entirely different kinds of conversations.

Most importantly, neither ‘side’ will ever agree. They just won’t. The best that anyone can work towards, I think, is a well regulated, extremely stringent law which both increases funding for hospice care and allows Assisted Dying. The model law is Oregon’s Death with Dignity Act.

Every year, the state of Oregon publishes an array of statistics which explain how the law was used the previous year. Here is the 2010 statistic that I think most people would benefit from knowing:

Most (96.9%) patients died at home; and most (92.6%) were enrolled in hospice care at time of death.

In fact, you can read all of the 2010 statistics here.

If you are in the UK, then you can still watch the documentary until Monday night for free on the BBC iPlayer.

If you are in the United States then I would suggest that you watch the Frontline documentary The Suicide Tourist. I discussed that documentary earlier this year and it is extremely good. It also follows a person to Dignitas who chooses to die.

Barring either of these options, I have embedded a short clip from Terry Pratchett’s documentary.

Rest assured, these conversations about Assisted Dying in the UK will continue.

Life After Kevorkian
He fought for the right to assisted suicide. Now what should we do with it?
William Saletan, Slate (June 3, 2011)

I am a member of the Kevorkian generation. Those of us in our mid-to-late thirties and onwards into our forties are usually called Generation X (for those who still remember the 1990s…) but I really think that we are Kevorkian’s kids.

Jack Kevorkian, who died last week, began assisting suicides in 1990. As soon as he started this work, debates began about the legality and ethics of assisted dying. I have distinct memories of these debates, which started during my high school years and carried on into college.

I and my peers came of age and entered adulthood surrounded by End-of-Life debates. Most people have mixed feelings about what Kevorkian did but at least he made people talk about death and dying. And those conversations have had an impact over the years.

So say what you will about Jack Kevorkian but he really contributed to a debate that informed an entire generation’s future. And as we all begin looking towards the End-of-Life for our own parents, I know that Jack Kevorkian’s influence will be felt.

The Slate article by William Saletan at the top is the best essay/article that I found after Kevorkian died.

Here is how Saletan concluded his piece and I wholeheartedly agreed with him point by point:

Kevorkian didn’t have the answers. But he raised the right questions. We can’t criticize his flaws, temper his ideas, and praise the hospice movement without acknowledging what he did. He forced an open conversation about the right to take your own life. Under what conditions, and within what limits, should that right be exercised? Even if it’s legal, is it moral? What do you do when a loved one wants to die? Kevorkian didn’t take those questions with him. He has left them to us.

The obituaries in both the Washington Post and the New York Times were also good.

What struck me most about Kevorkian’s death was how he died in the middle of a debate that he, alone, significantly pushed along.

This is also a debate that will most assuredly continue without him.

In mid-May, for example, large majorities of voters in Switzerland re-affirmed the right of individuals to choose an assisted death. The Swiss voters also (and more significantly) voted against proposals to ban citizens from other nations from using the Dignitas clinic, for example, to die.

Just this past week, the Personal Health columnist for the New York Times, Jane Brody, wrote a compelling column about New York Doctors who are not comfortable discussing End-of-Life decisions with their patients. Doctors in the state of New York are now required by law to discuss End-of-Life planning and some MD’s do not want to do it. The copy title for Brody’s column sums up the situation: Law on End-of-Life Care Rankles Doctors

And then last weekend, WNYC’s radio program On the Media ran a story on how the ‘Death Panels’ allegation used by opponents to President Obama’s health care law received press coverage which seemed to validate the absurdity of that claim.

I could go on and on with the examples. Indeed, a version of each of these stories has been previously covered by Meg, Kim, and myself since the Death Reference Desk began in 2009.

Here, then, is my point: Jack Kevorkian got an entire generation of young people, now in their mid-to-late thirties and soon to be in their late forties, thinking about dying, and in such a way that I can only hope it helps End-of-Life conversations with aging parents and elderly grandparents.

Jack Kevorkian didn’t inspire my generation, per se, but he played a much bigger role in our development than most people realize.

I will wrap everything up with a video obituary by the NewsHour on Public Television.

PBS NewsHour: Jack Kevorkian, Doctor who Brought Assisted Suicide to National Spotlight, Dies

Watch the full episode. See more PBS NewsHour.

The Suicide Tourist
Frontline (March 22, 2011)

On March 22, 2011, Frontline will re-broadcast its brilliant documentary The Suicide Tourist. This is an exceptionally well done documentary (even for Frontline) and it captures the end of one man’s life, Craig Ewert, with an unflinching gaze. I watched it last year. Unfortunately, the website version of the documentary is only available in America, which is too bad because everyone should watch this Frontline piece.

Here is the official explainer for The Suicide Tourist:

“I am dying. … There is no sense in trying to deny that fact,” 59-year-old Craig Ewert says of his rapid deterioration just months after being diagnosed with ALS, a motor neuron disorder often referred to as Lou Gehrig’s disease.

“I’m not tired of living,” explains Ewert, a retired computer science professor. “I’m tired of the disease, but I’m not tired of living. And I still enjoy it enough that I’d like to continue. But the thing is that I really can’t.”

Directed by Academy Award-winning filmmaker John Zaritsky, The Suicide Tourist is a portrait of Ewert’s final days as the Chicago native pursues a physician-assisted suicide in the one place where it’s legal for foreigners to come to end their lives: Switzerland. With unique access to Dignitas, the Swiss nonprofit that has helped more than 1,000 people die since 1998, The Suicide Tourist follows Ewert as he debates the morality — and confronts the reality — of choosing to die before his disease further ravages his body, and he loses the option to die without unbearable suffering.

“At this point, I’ve got two choices,” Ewert reasons. “If I go through with it, I die, as I must at some point. If I don’t go through with it, my choice is essentially to suffer and to inflict suffering on my family and then die — possibly in a way that is considerably more stressful and painful than this way. So I’ve got death, and I’ve got suffering and death. You know, this makes a whole lot of sense to me.”

Assisted suicide is legal in Switzerland and several other countries, as well as in two U.S. states. But only Switzerland allows outsiders to come in to end their lives, leading to criticism about “suicide tourism.” The Swiss government has recently countered by imposing greater restrictions on the sorts of cases Swiss doctors can approve for suicide, largely limiting it to those in the late stages of terminal illness who feel their lives have become unbearable — the same standard that’s in place in Oregon and Washington state.

“There are people who will look at this and say: ‘No. Suicide is wrong. God has forbidden it. You cannot play God and take your own life.’” Craig Ewert anticipates some of the objections to the act he’s preparing to carry out. “But you know what? This ventilator is playing God. If I had lived without access to technology, chances are I would be dead now.”

As Ewert journeys through Switzerland and is wheeled into the Zurich apartment rented by Dignitas where he will drink the lethal sedative that will end his life, his wife, Mary, stands by his side. She is there to kiss him goodbye and wish him a “safe journey” as the medication takes hold and his eyes close for the final time. “In a sense, I lost Craig six months ago as he was,” Mary Ewert explains. “[These last months] we probably had more of one another than maybe in the past. … You know, there may have been some people who still think, well, I wouldn’t have done that, or he shouldn’t have done that, or something. But if they felt that way, they didn’t say anything to me about it. … I [still] feel his presence. …”

The entire story is presented without sentimentality or moral judgement. It forthrightly and honestly follows Craig Ewert and his wife Mary as they travel to Dignitas in Switzerland. Many Death Reference Desk readers will have come across Dignitas either on Death Ref or in other situations. Dignitas was founded in 1998 by Ludwig Minelli and it remains one of the few places in the world that individuals can travel to, in order to end their life without hiding. Ludwig Minelli appears in the documentary and you can read a longer interview with him here.

The documentary speaks for itself, so I won’t drone on and on.

But watch it.

For those who are interested, the state of Oregon has now published its official 2010 Death with Dignity Act statistics. This is the annual report that Oregon files, as required by the DWDA, documenting how many individuals used the law and for what reasons.

These statistics are worth reading too.

Donating Body Can Save Families Money
Dan McFeely, The Indianapolis Star (February 08, 2011)

A short post on a perennial topic for the Death Reference Desk: how the dead body is transformed into some kind of cash value. Rarely, if ever, does this postmortem value involve direct cash exchanges, mostly because the law frowns upon such things. No, these are situations where a dead body is handed over to an institution of some kind in exchange for compensation of some kind.

So, as this article discusses, families donate a body to the Indiana University Medical School and in exchange for their donation receive significantly reduced if not totally free funeral services. More often than not, this means that the cremation of the remains (post dismemberment, more or less, by medical students) is covered by the institution receiving the body.

The author of this Indianapolis Star article, Dan McFeely, opens his article with this:

On average, Indiana University’s medical school has received about 240 donated bodies a year over the past few years — about twice as many bodies as it did a decade ago.

So many cadavers, in fact, that for the past two years, IU has sent some of the bodies to out-of-state universities, such as Drexel in Philadelphia and the University of Virginia.

What accounts for the increase of bodies at a time when annual cadaver donations in many other states are either stagnant or on the decline?

A lot of it can be traced to money.

Most American medical schools accept cadaver donations and gladly thank the next-of-kin with a non-cash gift of some kind. It’s true that even though money isn’t being exchanged there is still a quid pro quo involved…but not too many people that participate in any of this complain.

The bigger question to ask is this: What happens when medical schools, for example, start paying families with cold, hard cash for a dead body? The historians amongst you will already be thinking about Burke and Hare in Scotland, and that’s the historical example that usually scuttles these kinds of questions.

But I’m not so sure, given the economic conditions which many people currently face, that it won’t come to pass.

We’ve been adding story after story about these kinds of dead body transactions and you can see them all here: Death + the Economy.
Never say never…especially when dead bodies are involved.

Personal Health: Keep Your Voice, Even at the End of Life
Jane E. Brody, The New York Times (January 18, 2011)

Here is a quick follow-on article to the recent post on End-of-Life discussions in the American medical system.

Jane Brody, of the New York Times, has been writing for some time about the importance of End-of-Life planning with a person’s doctor. Her most recent column is a response to the Obama administration’s back and forth on Medicare funding for End-of-Life discussions between patients and physicians. I wrote about that recent debacle (for lack of a better term) two weeks ago. Brody’s writings have appeared before on the Death Reference Desk. In August 2009 I wrote about her push for End-of-Life planning in the (then) proposed American health care reform bill. You read that here.

Brody’s commitment to this issue is partly personal and she has been extremely open about the recent, unexpected death of her husband. She makes the following case for End-of-Life planning in her most recent column:

For many more of us these days, the end does not come swiftly via a heart attack or fatal accident, but rather after weeks, months or years battling a chronic illness like cancer, congestive heart failure, emphysema or Alzheimer’s disease. When doctors do not know how you’d want to be treated if your heart stopped, or you were unable to breathe or eat and could not speak for yourself, they are likely (some would say obliged) to do everything in their power to try to keep you alive.

A year ago, my husband was given a diagnosis of Stage 4 cancer. As his designated health care proxy, I had agreed long before he became ill to abide by the instructions in his living will. If he was terminally ill and could not speak for himself, he wanted no extraordinary measures taken to try to keep him alive longer than nature intended.

Knowing this helped me and my family avoid agonizing decisions and discord. We were able to say meaningful goodbyes and spare him unnecessary physical and emotional distress in his final weeks of life.

Not much else to say, really.

Donate Your Brain, Save a Buck
Gary Stix, Scientific American (January 4, 2011)
Hard times are making tissue donation more appealing

The Great Recession changed the way many people live—and its repercussions appear to be altering how some people choose to die.

At least two prominent tissue banks have seen an increase in the number of individuals who are interested in donating their bodies to research in exchange for a break in funeral costs.

This is isn’t an entirely new story: people donating their postmortem brains for medical science research in order to save on funeral costs. Death Ref has featured regular stories on this very topic in the Death + the Economy section. In fact, at one point in Autumn 2009 the Body Farm at the University of Tennessee stopped accepting dead bodies because it had received too many unclaimed bodies from local morgues. The Body Farm studies dead body decomposition, as well as other postmortem issues, to assist forensic investigators. Unclaimed dead bodies are not that extraordinary but the 2009 situation was different. In many cases, next-of-kin knew that the body was at the county morgue but couldn’t afford to retrieve said corpse.

So the uptick in cadaveric brain donation for research, and by extension a cut in funeral expenses is hardly surprising.

Indeed, the brain donation example is one of the current ways that the human corpse is being redefined as a source of biovalue.

Not purely a commodity but something rather close to it.

More on this in the future.