What is a “good death?” Well, it depends on who answers – a doctor, a patient, or a family member. Planning may be very helpful, for those who are inclined to talk about such matters beforehand, and the planning process can be very helpful in light of the likelihood of encountering “unexpected events.” Who decides this, how do we make the decision and why do we make a particular decision? I know, this is a lot of questions . . .
The legal question of “who decides” is by reference to several factors that include: the ability of the person receiving medical care to provide informed consent; whether there is an agent under a medical power of attorney (Power of Attorney for Health Care) and who is a surrogate decision maker or a proxy decision maker capable of deciding for someone.
The medical questions tend to arise from whatever sources inform our decisions around health care at the end of our lives. Here’s a good question – do doctors die differently than the rest of us? The answer is more often than not “yes.” What we can learn from them? Carolyn McClanahan’s article in Forbes posted 3/2/12 read it here is a good start. Here is another article that highlights the fact that many doctors shun the treatments so frequently offered to patients and their families. This is not an issue of doctors not following their own advice, patients and families choose which options will be selected – but instead illustrates that doctors tend to be much more realistic about likely outcomes for such medical interventions and often more concerned about quality of life. But it’s not really quite that simple – is it? Doctors as patients and doctors as doctors are two different matters. Illustration please!
Doctors giving a diagnosis of a disease that is terminal may be reluctant to deliver the bad news. Another sad truth is that most doctors view death as a “medical failure” and as the hospital-based internist who wrote this article observes, many family members of ailing elders look to doctors to “use their physician superpowers to push the patient’s tired body further down the road.” Sadly, many adult children have a very difficult time “letting go” of a parent. This is compounding situation to an already difficult scenario.
Now for the last question – the emotional considerations of end-of-life. Here is a list of some facts, with emotional implications.
Death is real and we each face it alone. If we have been living our lives, charting a course of changes throughout and experiencing the full range of emotions we are lucky to experience, we may feel better equipped to face or cope with another’s final change, the transition to death. What are some of the feelings of those who face their death with ?
“soul needs” include feeling heard by others, feeling cared for and connected to them and emotionally safe to express feelings – basically what we all want while we are alive!
“emotional needs” can include addressing any or all of the following feelings:
being afraid to die;
they are a burden to caregiver, family or community;
that they missed opportunities and their life has been wasted;
wanting to contact former friends or estranged family members;
anger at being cheated out of the length of their life;
perception of being lost and alone, and desperate for someone to ask how they feel;
angry at or feeling deserted by God; and
desperate to die and “get it over with.”
Emotions can also spring from any of the five stages described by Elisabeth Kuebler-Ross: denial, anger, bargaining, depression and acceptance.
We can say goodbye to someone and make peace with them before it is too late.
I have mentioned Dr. Ira Byock’s “four things” to say in previous posts (and I’m sure I’ll mention them again!):
Please forgive me
I forgive you
I love you
It’s best to think about this goodbye, because it will be the last one said to the dying person, and it will last the rest of your life! In the meantime, keep talking to each other and asking questions – even if you can’t answer the question . . .
©Barbara Cashman, LLC