Compassionate, informed advice about healthcare decision making

Archive for the ‘Death & Dying’ Category

Don’t Tell Me, “God protected you!”

Posted by

Morning paddle the day before the disaster.

I had a nearly fatal accident last week. In the end, I just got soaked from a capsize of my kayak and lost some items. I thank God I am alive. After reading my story, some very well-meaning people may say, “God protected you!” Being a very devout man and former healthcare chaplain…that is the LAST thing I’d want to hear.

Setting the stage for disaster

Access to take-out through high water

I took advantage of a break in my schedule, and several good weather days ahead, to go camping, kayaking, and biking. I was off to a new place for me, Bogue Chitto State Park in Louisiana, not far from the Gulf Coast. The park stretches out over several miles of the Bogue Chitto River.

The river was at flood stage, and moving very fast. I scouted it out for two days and estimated that it would take me an hour to paddle from the put-in to the take-out. The only unknown was what exactly the take-out would look like.

I took two trips there to assess it, by car and by bike. I could see the river, but I couldn’t see the riverbank where I had to take out because of the high water. So, I dropped a pin on the map on my phone so I’d know when to look for it and set off to start the paddle.

Disaster strikes

Pleasant, sunny break on sandbar on Bogue Chitto River, LA

It was a sunny but cool day. I had no problem navigating the high, swift water, and even took a pleasant break on a sandbar.

As I approached the take-out and got closer to the bank, the strong current slammed me sideways into a downed tree and I flipped over and went totally under. I was in my sit-on-top kayak so there was no popping back upright. There was also no righting the kayak because I have no idea how to do an Eskimo roll. Once I came above water again, I found my boat and paddle.

The next task was to get out of the fast-moving water. Swimming with considerable effort, I found a fallen tree near the bank and was able to hold onto it. I spent several

At this place on the bank I made my self-rescue.

minutes, still in the water, just catching my breath. Was it two minutes or five minutes? Those few minutes also gave me time to think, “This is not a good situation.” When I left, I had told no one I was paddling and when to expect me back.

Again, with much effort, I swam in water that was mostly over my head, pulling my boat from tree to tree until I found solid ground. I knew I was close to the take-out, so I walked through the woods dragging my boat until I got to the road and eventually to the take-out. I had left my bike there earlier, and was able to ride the several miles back to my car.

Some things went right…

Fortunately, I did a lot of things right. I had on my life jacket, cinched up tight. It literally saved my life. I have always worn a fanny pack attached to my body for things I did not want to lose. In it was my car key.

I also had secured my phone in my life jacket. I had it out moments before to check for the take-out and set it on the floor of the kayak. Then I thought, “Maybe I ought to secure this puppy.” I am so glad I did.

Journal was baptized after the capsize.

Because of the cool temperature, I wore wet suit pants and socks. My t-shirt and turtleneck were synthetic material, which retains some warmth even when wet. I never felt cold, partly because I was working so hard.

My biggest regret, besides getting too close to that fallen tree, was I did not secure my cochlear implant processor. I lost it in the tumble. Fortunately, I had my old processor in the car as a backup. I lost my hat and a bottle of water, too.

I never had a fear that I would die. I could have, but my life jacket saved me. There was a moment when I got separated from my boat that I feared I would not be able to get back to it and be dragged down river to who knows where. Thankfully, I was able to use my paddle to pull the boat back toward me.

It’s “No problem”

Sitting at camp that night, I was glad to be alive and warm by the fire before me. I reviewed the events of the day. I thought about my friend, Wayne, who once reframed life’s challenges for me simply using the phrase, “No problem.”

For a situation in which you have no control: “No problem, there is nothing you can do about it.” For a situation in which you CAN do something about it: “No problem, take steps to figure it out.”

For me, this mishap was the latter, and I got through it with a series of “no problems.” Submerged in the water? No problem, get above water. Lost my boat? No problem, pull it back with my paddle. Need to avoid being swept downstream? No problem, swim to shore, relax, catch my breath. Got to get back to the car? No problem, get into the woods and find the road.

That’s not what I was thinking during the unfolding disaster, everything happened so fast I had no time to think of anything but the task at hand. But you know what they say about hindsight.

A real miracle

In my 45 years of paddling, I have never swamped. I always prepare for the possibility, thus the attached and secure fanny pack, the life jacket, and wet suit. But I also always thought it was a remote possibility, thus I did not secure my cochlear device. The next morning, I typed a long journal entry on my computer (my journal got soaked in the spill). Here is an excerpt:

“I have thought about what a disaster yesterday could have been. Had I been swept underwater and pinned in a sieve of the branches of the tree, I would have been dead in minutes. They might not have found my body for weeks as the flood waters receded. A similar accident took the life of a very skilled kayaker in Great Falls, Virginia in 2013. She got pinned under water and drowned.

“So many random, chance happenings prevented the capsize from becoming a disaster. When I first started paddling years ago I asked canoe guide, Ralph Shaw, why flood waters on whitewater rivers are so dangerous. After all, when the water rises all the rapids disappear. He said it is the volume of water that is the danger. That is what toppled me yesterday. Once the massive flood caught the edge of my boat, I was at the mercy of those waters….

“…I can hear some well-meaning people saying to me, ‘God protected you.’ I don’t want to hear that. The reason being is the terrible implication for all those who do drown in similar situations. Or what about hundreds of my patients who died while I was a nursing home and hospice chaplain? Following this reasoning, God did not protect them. It is a view that God picks winners and losers.

“I CAN say, ‘I thank God I am alive.’ But not that God saved me last week. I think of Cheryl Strayed, whom I wrote about in my blog, when she just said, ‘Thank you,’ at the end of her 1,000+ mile hike on the Pacific Crest Trail. I am simply glad to be alive every day.”

The miracle is not that I did not die last week — the real miracle it is that I am alive in the first place.

________________________________________

Chaplain Hank Dunn is the author of Hard Choices for Loving People: CPR, Feeding Tubes, Palliative Care, Comfort Measures and the Patient with a Serious Illness and Light in the Shadows. Together they have sold over 4 million copies. You can purchase his books at hankdunn.com or on Amazon.

New, New Year’s Bucket List

Posted by

I’ve never been one for a “bucket list.” You know — the one with skydiving and climbing Mt. Kilimanjaro on it. Never thought of those things.

But, I do think of “things to do”. They come to mind, and I say to myself, “I really need to do this before I get so disabled or demented that I can’t finish them.”

For what it’s worth, here are some of mine.

  • Update our wills. It has been years since we last did this. We’ve moved to a new state—TWICE—Florida and now Mississippi. We’ve launched our daughter out from under our roof (never out of our hearts). There have been many other changes in our situation that make this update necessary.
  • Update our advance directives. I wrote a blog recently about Voluntary Stopping Eating and Drinking (VSED) by advance directive. I want to add instructions on when to stop hand feeding me if I have advanced dementia. Putting this in writing can be very easy to do with samples I linked in the blog. Then, of course, we need to have two friends over to witness my signature.
  • Review beneficiaries on retirement accounts. This one we have done recently but I’ll check again just to make sure they say what I want them to say.
  • Continue to gather my “memoir” for my kids and grands. I wrote a blog around my birthday in 2021 about “keeping your regret list short.” It was kind of a “bucket list” thingy and I mentioned the notebooks I had gathered for my children and their children. Well, I have written more since then, so I need to keep on gathering. I also print my favorite quotable-quotes file (36 pages long). Interestingly, I found among dad’s papers, a notebook he kept of his favorite quotes, probably dating from the 1950s. When I started my own compilation of quotes, I had no idea he had done the same.
  • Finish my “spiritual autobiography.” I am in a small group at church, and we all are writing a spiritual autobiography to share with the group. I have a draft and will continue of refine it. I want to get it in a form suitable to give a copy to each child and grandchild. My spiritual life is so central to who I am, and I want to let those who love me know what is bubbling up inside. I don’t think they have any idea.

These are all doable items — and so important to me.

What about you? What’s bubbling inside on your important “things-to-do” list.

________________________________________

Chaplain Hank Dunn is the author of Hard Choices for Loving People: CPR, Feeding Tubes, Palliative Care, Comfort Measures and the Patient with a Serious Illness and Light in the Shadows. Together they have sold over 4 million copies. You can purchase his books at hankdunn.com or on Amazon.

Does Hospice Hasten Death? Some say “yes”— Most say “no”

Posted by

Boy, was I blindsided?

I posted a quote from a study that examined the general public’s understanding of hospice on my Hard Choices for Loving People Facebook page. 30% of the respondents said they felt hospice hastens death. My Facebook post got hundreds of likes and comments, a lot of traffic for my humble page. I had no idea this would engender such a strong response.

“This morphine is wonderful”

Misconceptions can be based on misconceptions. When people hear that a friend is receiving morphine, they automatically think death is near. Not necessarily. Because of this close association of morphine with death and the association of getting on morphine in hospice, many assume that’s what hospice does — hastens death. Not so. Morphine controls pain and relaxes breathing.

I had an elderly patient once who was dying of respiratory failure. She was so short of breath that it was a major chore for her to move from her bed to a chair. She got great relief from morphine which she took for months before dying. She told me once, “I’ve always been opposed to drugs, but this morphine is wonderful.”

The coincidence of death after morphine

Many of the respondents to my post who agreed that “hospice hastens death” told stories of family members going on hospice and dying soon after. Why should this surprise us? Hospice requires that a patient is within six months of dying, although the average patient is only on hospice for two weeks.

I am sure it is just a coincidence that a patient receives a dose of morphine and dies shortly after. The family then thinks, “she died because they gave her morphine.” She did not. She was on hospice because she was dying, and she just happened to take her last breath after taking morphine.

No incentive for a hospice to hasten death

It makes no sense that hospice would want to hasten a patient’s death. The more days the patient is on hospice, the more reimbursement the hospice receives. It is totally against their financial interest to hasten death.

Hospices also want to make sure their patients are as pain-free as possible. Families of hospice patients fill out surveys after the death of their person. They rate the hospice on pain control, among other items.

So, yes, hospices use morphine to keep patients comfortable, not hasten death. They want to have the patient as long as a natural dying process will allow, and they want favorable survey results.

The research is clear; patients live longer on hospice

Many studies confirm that hospice patients live longer than nonhospice patients suffering from the same disease. One study looked at dementia patients. On average, the patients on hospice lived longer than those who never entered a hospice program.

Another study looked at five different kinds of cancer and congestive heart failure. Once again, the patients who were under hospice care lived longer than the nonhospice patients.

So, rest easy. If you have a life-limiting illness and want to live longer with a better quality of life, go into hospice as soon as possible.

________________________________________

Chaplain Hank Dunn is the author of Hard Choices for Loving People: CPR, Feeding Tubes, Palliative Care, Comfort Measures and the Patient with a Serious Illness and Light in the Shadows. Together they have sold over 4 million copies. You can purchase his books at hankdunn.com or on Amazon.

She Fasted to Hasten Death — VSED

Posted by

Rosemary Bowen was not terminally ill. She hastened her death by fasting. It took seven days.

Ten states and the District of Columbia allow for “medical aid in dying” (MAID). In those jurisdictions, terminally ill people with six months or less prognosis can get a prescription for a lethal medication in order to hasten their deaths. But what about patients not in one of these states or those whose life expectancy is greater than six months? VSED is an option.

Voluntarily Stopping Eating and Drinking (VSED) can be practiced by those seeking an earlier death. It’s what Rosemary did.

Rosemary Bowen, at 94, was living independently. She said she had had a wonderful life and did not look forward to a long, slow decline toward death. For years, she had been telling her children, “That her life would not be worth living if she had to depend on caretakers to feed her, dress her, and take her to the toilet.” Then, it happened. She fractured her back and went to rehab but was unable to live independently. That was enough for her.

Rosemary asked her daughter to video her so she could show others how to take control of their dying with VSED. The 16-minute video is available on YouTube.

VSED is a legal and, in my view, a morally acceptable way to end one’s life. It is based on several established principles in medical ethics. Affirming “autonomy” we allow patients to make decisions to reject any medical treatment — even treatments that could potentially save one’s life. Also, medically-supplied nutrition and hydration (for example, by a feeding tube) have long been understood to be a treatment that could be refused.

What Rosemary did was take these one step further as she choose to refuse food and water. She did this basing her decision on her own values:

  1. She valued independence above all else. Being dependent on others was an unacceptable quality of life.
  2. She did not want to be a burden on her family.
  3. She did not want to go the route of many of her friends who spent years declining in assisted living or nursing homes, facing one medical setback after another.

The importance of medical support during the process

Do not try this without medical support. Rosemary was able to get a hospice to care for her in her last days. Palliative care is also available to ease burdensome symptoms like pain and thirst. See “VSED Resources Northwest” for help with choosing this option.

“I am leaving life with great joy,” she says in the video. “I can’t tell you how content I am. I recommend it highly to do it this way.… The price of staying alive is having to live without quality and joy.… I feel so privileged to be exiting life like this and think of all the people who are wringing their hands and saying if only God would take you and all they need to do is give God a little help by holding back eating and drinking.”

At one point in the video, she is on the phone saying goodbye to friend. As she signs off, she says, “I’ll see you in heaven.”

Indeed.

________________________________________

Chaplain Hank Dunn is the author of Hard Choices for Loving People: CPR, Feeding Tubes, Palliative Care, Comfort Measures and the Patient with a Serious Illness and Light in the Shadows. Together they have sold over 4 million copies. You can purchase his books at hankdunn.com or on Amazon.

I’m On a Podcast This Week

Posted by

I am interviewed by Dr. Saul Ebema on the “Hospice Chaplaincy Show” this week. He has a great podcast for hospice chaplains that I listen to regularly. Click here for access to the show.

________________________________________

Chaplain Hank Dunn is the author of Hard Choices for Loving People: CPR, Feeding Tubes, Palliative Care, Comfort Measures and the Patient with a Serious Illness and Light in the Shadows. Together they have sold over 4 million copies. You can purchase his books at hankdunn.com or on Amazon.

“To be wise is to be eternally curious.” — Buechner

Posted by

Frederick Buechner died recently at 96. There is a generation of ministers, myself included, who sought “the Buechner quote” to spice up a sermon. Here are some samples from my files (bold emphasis mine):

“There is a difference between a happy life and in living a meaningful life.… Living a meaningful life has to do with being a giver.… If you want to find meaning in your life you have to begin reaching out.… Happiness and unhappiness does not predict suicide but living a life without meaning does.”

The place God calls you to is the place where your deep gladness and the world’s deep hunger meet.”

“If you don’t have doubts, you’re either kidding yourself or asleep. Doubts are the ants-in-the-pants of faith. They keep it alive and moving.”

“It is as impossible for man to demonstrate the existence of God as it would be for even Sherlock Holmes to demonstrate the existence of Arthur Conan Doyle.”

“To be wise is to be eternally curious.”

“Thus, when you wake up in the morning, called by God to be a self again, if you want to know who you are, watch your feet. Because where your feet take you, that is who you are.”

Believing in him is not the same as believing things about him such as that he was born of a virgin and raised Lazarus from the dead. Instead, it is a matter of giving our hearts to him, of come hell or high water putting our money on him, the way a child believes in a mother or a father, the way a mother or a father believes in a child.”

“God himself does not give answers. He gives himself.”

“Listen to your life. All moments are key moments.”

“Faith is stepping out into the unknown with nothing to guide us but a hand just beyond our grasp.

“When you remember me, it means you have carried something of who I am with you, that I have left some mark of who I am on who you are. It means that you can summon me back to your mind even though countless years and miles may stand between us. It means that if we meet again, you will know me. It means that even after I die, you can still see my face and hear my voice and speak to me in your heart.”

________________________________________

Chaplain Hank Dunn is the author of Hard Choices for Loving People: CPR, Feeding Tubes, Palliative Care, Comfort Measures and the Patient with a Serious Illness and Light in the Shadows. Together they have sold over 4 million copies. You can purchase his books at hankdunn.com or on Amazon.

Alone into the Alone — “A Grief Observed” Revisited

Posted by

Why?

Why, late in his career, would an internationally famous Christian author publish a personal memoir under a pseudonym? He hid both his identity and that of his beloved wife. Why?

I was leaving on one of my daily bike rides recently and needed to pick a new book to listen to. I selected a reread — A Grief Observed (1961). But, the author was identified as N.W. Clerk in the original rendering. Only after his death in 1963, was it published as by C.S. Lewis.

So, I am peddling the hills of Oxford, Mississippi, and I am being reminded just how good this book is. Between 1940 and his marriage in 1956, this confirmed bachelor wrote his greatest works including The Screwtape Letters (1942), The Chronicles of Narnia (1950-56), and Mere Christianity (1952). His brief four-year marriage to the terminally ill Joy led to A Grief Observed.

Lewis traced his wife’s life with cancer, then death and then his grief in this very thin volume (my copy has 53 pages of text.) Only, she is not “Joy,” who became his wife when he was 57 and she 41. In A Grief she is “H.” Her full name was Helen Joy Davidman, thus the “H.” They were actually married in the hospital where she was receiving treatment.

Here is a sampling of this grief journal by one of the 20th century’s greatest writers and Christian apologists.

“No one ever told me that grief felt so much like fear. I am not afraid, but the sensation is like being afraid.”

Years ago, I had memorized this first line of the book. C.S. Lewis starts his journaling describing how grief feels to him. He keeps this up on every page.

“For in grief nothing ‘stays put.’ One keeps on emerging from a phase, but it always recurs.”… “Grief is like a long valley, a winding valley where any bend may reveal a totally new landscape.”

How many times have I heard this? I have to remind grievers “you never ‘get over’ grieving.” Lewis sees it as a series of emerging phases always recurring. He likens it to a hike through a valley.

“Meanwhile, where is God?… But go to Him when your need is desperate, when all other help is vain, and what do you find? A door slammed in your face, and a sound of bolting and double bolting on the inside. After that, silence.” 

This might come as a surprise to those who found Lewis’ writings on Christianity so helpful. He had doubts. He didn’t doubt the existence of God but that his beliefs did not take away the pain of grief. He had no time for the “trust God and all will be good” line of thinking. Perhaps, this is why he wrote under a pseudonym. Doubt was so far from the assured Lewis.

“It is incredible how much happiness, even how much gaiety, we sometimes had together after all hope was gone.” 

Here seems to be a great contradiction. In the midst of no hope for cure, Lewis and his wife had great happiness. There is a scene in Shadowlands, the biopic about their life together and her death. Lewis tells Joy not to talk about her impending death. He doesn’t want to spoil their good time together. She says, “It doesn’t spoil it, it makes it real.… I’m going to die and I want to be with you.… The pain then is part of the happiness now. That’s the deal.”

“She said not to me but to the chaplain, ‘I am at peace with God.’ She smiled, but not at me. Poi si torno all’ eterna fontana.” 

These are the last words in A Grief Observed. He was able to witness the exchange between his dying wife and a chaplain. She was at peace. He closed with a Latin line from Dante’s Divine Comedy. In English, “Then she returned to the eternal source.”

________________________________________

Cover Photo by Ricardo Gomez Angel on Unsplash

Chaplain Hank Dunn is the author of Hard Choices for Loving People: CPR, Feeding Tubes, Palliative Care, Comfort Measures and the Patient with a Serious Illness and Light in the Shadows. Together they have sold over 4 million copies. You can purchase his books at hankdunn.com or on Amazon.

More Nothing than Something — True Solace is Finding None

Posted by

I was such a scaredy-cat at 8 years old. All I can remember of two particular movies in 1956 was that I kept my eyes closed during the entirety of each film. I have just discovered, through Wikipedia, that Earth Vs. The Flying Saucers and The Werewolf were released together as a double feature that summer. Who knew?

Bingo. Those were the two movies of my childhood fears. I was sitting through 160+ minutes of terror.

From my youth, outer space and the heavens brought a recuring sense of awe. Yes, the fear of flying saucers invading was real. But, there was also a sense of reverence as I gazed into the night sky. I was pretty small in the vastness of the stars above.

I just placed the latest “deep field” photo from the new James Webb Space Telescope to my home screen on my iPhone. This is a time exposure photo of a portion of the night sky the size of a grain of sand held at arms-length. Thousands of galaxies appear as we look back billions of years. Each galaxy has billions of stars — each star is not unlike our sun.

We come out of childhood, hopefully, putting away childhood fears. We gain a sense of control of our own lives. I am somebody. That is, until….

That is, until something reminds of how small we really are — how we really are not in control. Serious illness ranks up there with things that shake us to our core.

The Deep Field photo brings so many thoughts to my mind. What is really amazing is that there is more of nothing than there is of something. More empty space than stars. Perhaps “nothingness” is more important than “something.”

Even down at the microscopic level, scientists tell us that the is more empty space in each atom than solid matter. Doesn’t make sense when you fall on asphalt after a spill off your bike, but, I have to take the experts at their word.

The point is that emptiness and nothingness are where we live. Yes, I am glad I have family, friends, community, and this beautiful earth to enjoy. But, I also feel at home in the vastness of empty space or the silence which is a space empty of sound.

It is the message of the mystics and the dying have been telling us since the dawn of time. I am reminded of Gretel Ehrlich’s comment, “True solace is finding none. Then, of course, it is everywhere.”

________________________________________

Chaplain Hank Dunn is the author of Hard Choices for Loving People: CPR, Feeding Tubes, Palliative Care, Comfort Measures and the Patient with a Serious Illness and Light in the Shadows. Together they have sold over 4 million copies. You can purchase his books at hankdunn.com or on Amazon.

Being Sued for SAVING the Life of a Patient

Posted by

“I’ll drag mother down to my car and take her to the emergency room myself,” she told me.

The patient had left verbal and written instructions that she did not want to have life-saving treatments when she was dying. A “No CPR” order was on her chart. Knowing her daughter’s feelings, the old lady chose her son as her power of attorney. She conspicuously omitted any mention of her daughter in the document.

I met this patient, her son, and daughter while I was a nursing home chaplain. By that time, the patient had severe dementia, so healthcare decisions were in the hands of the son. The daughter commented about taking her mom to the emergency room in one of our earlier conversations.

A recent issue of Hospice News featured a story about how healthcare institutions are open to lawsuits if they do not honor a patient’s wishes to refuse life-sustaining treatment. We almost always think it is the right thing to save a life. But there are cases of “wrongful life.” That is, saving a patient’s life who had chosen to let a natural death happen.

As it typically happens, the nursing home patient I ministered to went into a slow downward decline. Even the daughter eventually realized that when her mother’s heart finally stopped, it was time. Thankfully, there was no schlepping the poor old lady into the car.

________________________________________

Chaplain Hank Dunn is the author of Hard Choices for Loving People: CPR, Feeding Tubes, Palliative Care, Comfort Measures and the Patient with a Serious Illness and Light in the Shadows. Together they have sold over 4 million copies. You can purchase his books at hankdunn.com or on Amazon.

On The Other Hand, “I don’t want to die at home.”

Posted by

Conventional wisdom says, “A good death is at home with my family gathered around me.”

An alternative view says, “I don’t want to die at home.”

How many times have we seen in an obituary, “He died peacefully at home with his family gathered around him.” Families wear this as a badge of honor. They provided the best of care and met the patient’s wishes to remain at home.

Home is generally considered the preferred place to die. For the first time in generations, more people are dying at home than in the hospital*. I have seen some studies that consider dying at home, as opposed to dying in the hospital, as a “good outcome.”

“Not so fast, my friend.”

“Not so fast, my friend,” as Lee Corso would say on College Game Day. Many people die away from home by choice. As I said in a previous blog, there are some people who just feel more comfortable dying in the hospital. Some families do not want to live in a home where a family member died.

I have a friend who is in his 70s and his preference is to die away from home. He is in a second marriage, this time to a widow. He does not want to put his wife through the caregiving burden again.

Besides, he told me, he has so far paid for long term care insurance for years and would hate for all that money to go to waste. With the insurance, he is prepared financially to live for years in assisted living or a nursing home. “I will not put her through that again,” he said.

*See a recent article in the New England Journal of Medicine, “Where Americans Die — Is There Really ‘No Place Like Home’?”

________________________________________

Chaplain Hank Dunn is the author of Hard Choices for Loving People: CPR, Feeding Tubes, Palliative Care, Comfort Measures and the Patient with a Serious Illness and Light in the Shadows. Together they have sold over 4 million copies. You can purchase his books at hankdunn.com or on Amazon.

________________________________________

Cover Photo by Zac Gudakov on Unsplash

Quality of Life Publishing Logo

Quality of Life Publishing Co. is the proud publisher of Hank’s books, as well as other branded educational materials for health care & end-of-life care.

www.QOLpublishing.com

Copyright 2024, Hank Dunn. All rights reserved. Website design by Brian Joseph Studios

Volume Discounts for Branded Book Orders

Minimum quantity for branded books is 100. English and Spanish branded books are sold separately. Click here for more information or contact us with questions.

Black

  • 100 to 249 copies: $4.50 each
  • 250 to 499 copies: $3.50 each
  • 500 to 999 copies: $3.00 each
  • 1000 to 1499 copies: $2.25 each
  • 1500 to 1999 copies: $1.75 each
  • 2000 to 3999 copies: $1.60 each
  • 4000+ copies: $1.45 each

Color

  • 100 to 249 copies: $7.00 each
  • 250 to 499 copies: $4.50 each
  • 500 to 999 copies: $3.50 each
  • 1000 to 1499 copies: $2.50 each
  • 1500 to 1999 copies: $2.00 each
  • 2000 to 3999 copies: $1.85 each
  • 4000+ copies: $1.70 each


Volume Discounts for Unbranded Book Orders

Each title/language sold separately.

  • 1 to 9 copies: $8.00 each
  • 10 to 24 copies: $5.75 each
  • 25 to 49 copies: $4.50 each
  • 50 to 99 copies: $4.00 each
  • 100 to 249 copies: $3.50 each
  • 250 to 499 copies: $3.00 each
  • 500 to 999 copies: $2.50 each
  • 1000 to 1499 copies: $2.00 each
  • 1500 to 1999 copies: $1.50 each
  • 2000 to 3999 copies: $1.35 each
  • 4000+ copies: $1.20 each