End-Of-Life Care For Death With Dignity!

An Electronic Mental Health Newsletter from Joel I. Kimmel, Ph.D., P.A. & Associates
Volume 11, Number 3

March heralds the arrival of Spring and is a time for new growth and rebirth. It is also National Nutrition Month. Created by the Academy of Nutrition and Dietetics, its purpose is to focus attention on the importance of making informed food choices and developing good eating and physical activity habits. How we eat, when we eat, and why we eat are as important as what we eat. Eating can be a very enjoyable activity but consider eating nutritious and flavorful foods. Now is a good time to consider your eating patterns and whether you are eating right.

This month’s E-Letter focuses on End-Of-Life Care For Death With Dignity! This information can be also downloaded from our E-Letters tab on our website. Our email of the month is about 10 Household Cleaning Supplies and our Ask the Doc question is about caretaking an elderly mother. We hope you find the enclosed information helpful. We also thank you for reading our E-Letters and for the many comments we have received through our over 11 years of E-Letters.

Practice News

Job Opening. We are currently looking for a licensed mental health professional with at least 2 years of experience to affiliate with our practice. This is a terrific opportunity for an individual practitioner to join our well established practice and develop their own caseload. Preference will be given to those who have experience treating children. If you are interested or want more information, please email DrKimmel@KimmelPsychology.com.

Depression groups. Our ongoing weekly depression therapy groups meet regularly in our office. A men’s support group and a women’s support group are run by Dr. Jim Kaikobad and meets for one and one-half hours. The group is educational, supportive, and confidential and is limited to 8 people. A third and fourth group will be starting soon. If you are interested in attending, please contact Jillian at 954 755-2885.

Afterschool Tutoring. Tutoring for students in grades 1 through 8 is being offered after school in our offices. Jill Kimmel, an experienced educator, will be helping students to understand and learn their academic concepts as well as provide assistance in doing homework. To find out more about our tutoring services as well as to schedule an appointment, please contact Jillian at 954 755-2885.

Handouts from previous E-Letters can be found at the E-Letters page on our website, www.KimmelPsychology.com. We invite you to read and download them if desired.


Our E-Letter this month focuses on a very difficult and emotional topic for many of us. That is, facing the inevitability of our own death and being prepared for it. Advances in medicine and medical treatments have prolonged life far beyond original age expectancies. A person can now be kept alive who in the past would have died from their illness or injury. As a consequence, there are now certain ethical and legal questions that affect the doctor’s role as well as the rights of the patient and their family. For example, every American has the constitutional right to request that medical treatment not be provided or to actually receive it. These decisions are obviously not easy but understanding the options and getting answers to certain questions can make this task somewhat easier. Being prepared can allow us to remain in a state of dignity until the very end.

To begin, a person must face their fears and other emotions about the eventuality of dying. Once we accept that we cannot prevent our own deaths, we can plan for it. When confronting your fears, consider whether you are fearful of pain, loss of dignity, not being able to communicate, losing your memory, lingering in a state of unconsciousness, leaving loved ones behind, leaving unfinished projects, and not having enough financial resources. One of the best ways to deal with these fears is to plan ahead and make decisions about end-of-life care. It is advisable to talk with family members and share with them your thoughts, feelings, wishes, and decisions. While this conversation will be difficult, they will be able to make sure that you get the care you want. This will also prevent them from having to make difficult decisions while they are grieving. Doctors should also be told about these decisions so they can follow your directives.

In making your decisions, try to answer these questions:

  • Whom do you want to make decisions for you if you are unable to make them?
  • Do you want to be resuscitated and if so, under what conditions?
  • What other medical treatments will you accept?
  • Do you want to be hospitalized or stay at home?
  • Do you want to be sedated?
  • Will your family have adequate financial resources to pay for your treatment?
  • What can you expect to happen at the end-of-life?
  • Will medical treatments improve the quality of life or just prolong it?
  • What will happen if your family disagrees with the medical team?
  • Advanced directives are written instructions that will communicate your decisions. These are tools that consist of a living will and a durable power of attorney for healthcare. A living will describes your decisions about end-of-life care in case you are no longer able to speak. Try to be clear and specific about your decisions in these instructions. Give a copy to your family and to your doctor. A durable power of attorney for healthcare names a representative or agent to make end-of-life care decisions for you if you are unable to. This person may be a trusted family member or friend and someone who knows your values and religious beliefs. It is a good idea to designate an alternate who also knows your ideas about end-of life care. Try to provide as many answers to questions as you are able to. These forms are available on the internet, from state and local governments, from certain organizations, and possibly from your doctor. Other instructions you can leave include a DNR or Do Not Resuscitate order which informs medical personnel not to resuscitate you. A Do Not Intubate order requests that a tube attached to a ventilator not be placed into the trachea to assist in breathing.. A preferred intensity of care form instructs your doctor how to provide care under certain circumstances.

    You can also make decisions about the different types of end-of-life care. These include curative treatment which is any medical care given to you to cure any illness or injury to live longer. Palliative care provides relief from pain and may also provide spiritual and emotional support for you and your family. Hospice care provides palliative care for those close to the end of their lives. Another treatment is artificial nutrition and hydration where doctors put a tube down the esophagus into the stomach. You can also decide what kind of health care you do not want as well as whether you want to make any organ donations.

    By making theses end-of-life care decisions, we can take some control over our own deaths and consequently enhance our dignity. We can make known where we want to be, who will be with us, and what we want to happen. We can arrange before hand for financial expenses and legal planning so as not to burden our loved ones. Through accepting our own deaths and planning for it, we also help our loved ones to accept it.

    We offer the following information on End-Of-Life Care For Death With Dignity! (You can download the following from our E-Letter page on our website.)


    In the end, it’s not the years in your life that count.
    It’s the life in your years —Abraham Lincoln


    • Although difficult, many people are now facing decisions about death and dying because of medical advances that are prolonging people’s lives
    • As people, we tend to plan: our schooling, our work, our family, our vacations, and our finances yet most of us do not plan for the end of our lives
    • Decisions about dying and medical care are often made when the family is most vulnerable, emotional, and in need of comfort and support
    • Thinking about our own or our loved one’s deaths is quite difficult and emotional; we tend to avoid those decisions yet planning ahead can ease the burden
    • Making end-of-life care decisions when healthy allows one to maintain their values, make the right choices for themselves, and unburdens family members
    • Considering end-of-life decisions requires facing any fears one might have about being in pain, losing one’s dignity, losing one’s memory, not being able to communicate to others, being unconscious, and leaving family and loved ones behind
    • When making these decisions, it is important to discuss thoughts, feelings and fears with family members as well as what kind of end-of-life care you want
    • Different types of end-of-life care include:
    • Curative care is any medical treatment designed to help you live longer
    • Palliative care helps provide relief from pain and provides support for you
    • Hospice care provides palliative care for those close to dying
    • Typical questions include:
    • Who will make health care and financial decisions for you if incapacitated
    • Will you want to be hospitalized or stay at home if terminally ill
    • Do you want to be resuscitated
    • What medical care will you accept and not accept
    • What happens when a person dies and what decisions will need to be made
    • Tools to communicate one’s wishes about future care are called advance directives and consist of living wills and durable powers of attorney for healthcare
    • A living will allows you to write down your wishes about medical treatments to guide your family and doctors at the end of your life when you may not be able to communicate
    • A durable power of attorney for healthcare authorizes a specific person to deal with all medical situations when you cannot speak for yourself
    • Other questions to consider include whether to donate your organs and how healthcare expenses will be paid for
    • WHAT TO DO!

        • Recognize and accept that death is inevitable and will be a difficult time for family
        • Have a discussion about your thoughts, feelings, and wishes for your end-of-life
        • Allow them to express their feelings
        • Complete a living will and durable power of attorney for healthcare
        • Decide about organ donation, healthcare expenses, and resuscitation orders
        • Seek professional help if you have emotional difficulty making these decisions
        • WE CAN HELP!
          Call us at (954) 755-2885 or email us at drkimmel@kimmelpsychology.com

          Joel I. Kimmel, Ph.D., P.A. and Associates 5571 N. University Drive, Suite 101 Coral Springs, Florida 33067

          Copyright © 2016; by Joel I. Kimmel, Ph.D.
          As always, we would like to welcome new readers to our e-Letter. We hope that you find it informational and enjoyable. We invite you to share this e-Letter with others. If you have received this from a fellow reader, please send us your email address to include you on our list.

          Ask The Doc

          R.H. writes: I live with my mother who is 88. She is in good health and has all her faculties but she needs constant care. We do have two aides but they are not reliable. Basically, I am the caregiver. She refuses to go into an assisted nursing facility and I am worried that she will go downhill if she does. After work, my life centers on taking care of my mother. Although I love her, I feel trapped like I have no life of my own. I know there are not many solutions but can you help?

          This is a very difficult situation as you seem to be torn between wanting to live your own life and the responsibility you feel to take care of your mother. This situation is happening more and more frequently as people are living longer and may not have the means or desire to enter assisted living. In fact, many elderly are very anxious about assisted care as they don’t trust the staff, they do not want to give up living in their homes, they don’t want to give up their independence, and they also recognize that most likely, they will not be coming home once they leave.

          Here are some suggestions for you to accept and cope with the situation the best that you can. Recognize that your feelings will include frustration and anger. Accept that these are typical and do not deny them. Discuss your frustrations with others and keep a feelings journal. Attending a caregiver’s group can be quite supportive as you will realize that others have the same feelings as you and that you are not alone. If possible, rely upon other family members to share in your care for your mother. Remember the reasons why you accepted being a caretaker and recognize that it is demanding. Whenever possible, try to get free time for yourself and make sure you use it to do the things you enjoy. Keep in social contact with others even though you may not see them often but this will prevent a sense of isolation. At some time your job will end but take some satisfaction in how your mother benefits from your caretaking of her.

          Email of the Month

          We thank Jessica S. for the following email:

          10 Household Cleaning Supplies

          1. Use white bread to: Dust an oil painting. Gently dab a slice of white bread over the surface to pick up dirt and grime.
          2. Use ketchup to: Remove tarnish from copper and brass cookware. Squeeze ketchup onto a cloth and rub it on pots and pans. They should go back to their coppery color in minutes. Rinse with warm water and dry with a towel.
          3. Use oatmeal to: Scrub very dirty hands. Make a thick paste of oatmeal and water; rinse well.
          4. Use rice to: Clean the inside of a vase or a thin-necked bottle. Fill three quarters of the vessel with warm water and add a tablespoon of uncooked rice. Cup your hand over the opening, shake vigorously, and rinse.
          5. Use tea to: Scour rusty garden tools. Brew a few pots of strong black tea. When cool, pour into a bucket. Soak the tools for a few hours. Wipe each one with a cloth. (Wear rubber gloves or your hands will be stained.)
          6. Use glycerin to: Remove dried wax drippings from candlesticks. Peel off as much wax as possible, then moisten a cotton ball with glycerin and rub until clean.
          7. Use club soda to: Shine up a scuffed stainless-steel sink. Buff with a cloth dampened with club soda, then wipe dry with another clean cloth.
          8. Use hydrogen peroxide to: Disinfect a keyboard. Dip a cotton swab in hydrogen peroxide to get into those nooks and crannies.
          9. Use cornstarch to: Clean grease spills on carpets. Pour cornstarch onto spots and let sit for 15 to 30 minutes before vacuuming.
          10. Use alcohol to: Erase permanent-marker stains from finished wood floors or solid-surface countertops. Pour rubbing alcohol onto a cotton ball and apply.

          Till April…

          If you no longer wish to receive future E-Letter reminders, please send an email to DrKimmel@KimmelPsychology.com requesting to be removed from this list.

          If you find this information interesting or helpful, please forward this E-Letter to your contacts and friends. Copyright © 2016 by Joel I. Kimmel, Ph.D. P.A. and Associates.