By MYRON LOVE They say there are two things you can count on in life – death and taxes.  I don’t know about taxes – but no one escapes death.
 When we are younger, few give much thought to dying. As we age though, we come ever closer to that final reality.  The best we can hope for – in my view – is to live to a relatively old age in relatively good health and pass away quickly – preferably in your sleep.
 
So what would one consider a “good death?” That was one of the questions that was discussed by a panel of three experts on the subject who appeared together on Sunday, November 24, in a program at the Chesed Shel Emes titled: “The Last Stop – Reflections on Living and Dying”.
 (The Chesed Shel Emes is our community’s non-profit Jewish funeral chapel; the only one of its kind in North America).
 
About 180 people were in attendance – both in person and online, as independent Rabbi Matthew Leibl, palliative care specialist Dr. Bruce Martin, and Dr. Harvey Max Chochinov, a psychiatrist who is one of the world’s authorities on the subject of the emotional aspects surrounding death and dying, shared their experiences and perspectives.  Alison Gilmur, popular culture and lifestyles reporter for the Free Press. served as the moderator.
 A “good death” – as opposed to a “bad death” – is important for patients and families alike, Chochinov noted.

 “Is dying in your sleep a good death?” Rabbi Leibl asked.  “That depends on both the individual and the family. It certainly doesn’t give the individual much time to think about it beforehand.  I think the major concern for most people is that death be as painless as possible.”
 “The problem is that you only die once,” Chochinov pointed out. “There is no rehearsal.  Many fear the unknown. And you don’t know what the path will be, what it will be like for you. Or if you will still be you afterward.”
 
Gilmour asked the panelists what people fear most about dying? Chochinov cited the case of one woman who refused to take her medication because she feared it would make her confused – the way it had her mother prior to her death. Reassuring her that she was in capable hands allowed her to accept proper pain management and die peacefully.
 
 Another anecdote from Chochinov concerned  the case of a young woman who was facing death – with a young family and a young child at hand.  “She was concerned that her little girl would have no memory of her,” Chochinov noted.  “We completed something called Dignity Therapy, which allowed her to create a written legacy that would eventually be shared with her child.”
 
Rabbi Leibl referred to a member of the Shaarey Zedek who had been suffering for some time.  She chose to die at home but, before her passing, she asked her children to leave the room. She and the rabbi talked.
 “I asked if she was afraid,” he recalled.  “She said that she wasn’t afraid, but that she worried that she would never see her family again.”
 Dr. Martin noted that every death is personal.  “There is no common thread,’ he said.  “A last conversation can be profound or trivial.
“One concern for the dying is not being able to live to see their grandchildren grow up and the shared moments they will miss.”
 Chochinov also added that some people are worried about the process of dying and what it may be like.  “While dying is inevitable, suffering ought not to be”.
 Gilmour asked what people can do to help comfort someone who is dying? 
Chochinov’s answer was simple: “Be sure to show up”. “When you know someone is dying,” he noted, “for many the impulse is to stay away, to withdraw.  You don’t know what to say,” he observed.  “Don’t try to fix what can’t be fixed.  But do show up and listen.”
 
Martin recalled a former mentor who suggested that the most important question that someone who is visiting someone who is terminally ill is: ‘What can you do to help?’ “
 
“People who are dying don’t need to be reminded about it,” Rabbi Leibl observed.  “Although every case is different, a visitor should talk to the afflicted individual the same way you would talk to anyone else. You can talk about life, for example, or what you are reading, or a show you are  watching together.”
 
Gilmour concluded her questioning by bringing up the issue of government-approved Medical Assistance in Dying (MAID) – medically assisted suicide.
 
A number of liberal rabbis Are in favour of MAID, Rabbi Leibl noted.  “Judaism however dictates that we must do everything we can to prevent death,” he pointed out. 
“I have officiated at funerals for a few people who have chosen IAID,” he reported.  “One such funeral was for a Holocaust survivor – in her 90s. I spoke with her the day before she died.  She was at peace.  I viewed what she was doing as courageous.”
 
Chochinov said it is also important to look at factors that can undermine a patient’s will to live, such as poorly controlled pain, limited access to palliative care and lack of supports, including respite.“MAID is driven by a desire for personal autonomy,” he observed.  “It was originally designed as an option for patients who were suffering and facing a reasonably foreseeable death.” Eligibility criteria have been expanded, making patients not imminently dying, but suffering, able to request MAiD.He expressed grave concerns about extending MAiD for people who are mentally ill.  “We simply can’t know which of these patients might improve with adequate time, support and care.”
 In response to a later follow-up question from a member from the audience, Bruce Martin added that, in the case of people with dementia and MAID, the latter may prevent children and grandchildren from spending more time with the parent/ grandparent.  After all, who then decides when the time is right?
 The panelists were asked about talking about death and dying and how to cope. Martin noted that when he speaks to kids in schools, there is a lot of interest in the subject.      
 A question about planned giving elicited a comment from Chochinov about the importance of not only leaving a will, but letting family know what your wishes are. “It’s never too early to talk about these things”, he said, “but if you put it off long enough, there may come a time when it’s too late”.