Approaching Death With Dignity

According to Kevin Quiles, MDiv, a licensed professional counselor, former hospice chaplain, and author of the books Spiritual Care to Elderly and Dying Loved Ones and Conversing with Death: To Build a Better Now and Future, cultural pressure is one major influence that shapes the way people think about and talk about death. “Cultural fears push us daily to think about youthful appearance, permanent states of health, and an ideal longevity,” he told Psychiatry Advisor. “This pressure is so dominant that it even shapes caregiving professionals to avoid serious thought on personal end-of-life issues that await everyone.” He also stated that invisible norms prohibit open dialogue regarding death and dying.

Despite being seen as authorities on such issues, many healthcare professionals lack training on how to discuss terminal diagnoses and end-of-life issues, says Ann Neumann, author of the recently published book The Good Death: An Exploration of Dying in America. Training clinicians in these areas would be an important step in shifting cultural taboos around discussing death, and increased training in pain cessation would better equip clinicians in meeting patients’ end-of-life needs.

As a hospice volunteer and in research for her book, Ms Neumann consistently found that “a good death came down to meeting the specific needs and expectations of the patient,” considering the vastly different circumstances and preferences of each individual. “The skill of good doctors, caretakers, clergy, and patient supporters is to learn what the patient wants, to not make assumptions, and to be frank — with themselves, the patient, and the care team — about their particular roles in the patient’s care,” she said. A good first step could be simply asking patients what they know and what they would like to know.

As a way to start the dialogue about death and dying, Dr Meier and colleagues often tell patients to hope for the best but prepare for the worst. Though it can certainly be unpleasant to talk about death, patients often find it therapeutic to express their beliefs about it and acknowledge their end-of-life desires and needs. “Death is a universal phenomenon that we all will experience, and the more we begin to talk about it, the less ‘death phobic’ our culture will become,”  Dr Meier said.

Mr Quiles, who trains healthcare professionals to explore the topic of their own death, advises them to begin a regular practice of reflecting on the impermanent nature of life. He believes the best way for clinicians to help patients or clients confront the topic is to first engage in their own existential work to “become aware of their own resistances to death and honestly grapple with this angst.” Learning to accept the reality that we will die and that everything we work to attain and maintain will end is a lifelong practice, he said.

Dr Meier hopes her team’s findings will bring awareness to discrepancies among end-of-life preferences and encourage healthcare providers to work with patients and family members to facilitate a successful dying process. “All individuals are entitled to a good death, and in order to provide the best care possible it is essential that we are listening to our patients’ voices, honoring their wishes, and providing excellent end-of-life care,” she said.

References

1. Meier EA, Gallegos JV, Montross Thomas LP, Depp CA, Irwin SA, Jeste DV. Defining a good death (successful dying): Literature review and a call for research and public dialogue. Am J Geriatr Psychiatry. 2016;24(4):261-271.

2. Quiles K. Spiritual Care to Elderly and Dying Loved Ones. Naples, FL: Quality of Life Publishing; 2010.

3. Quiles K. Conversing With Death: To Build a Better Now and Future. West Conshohocken, PA: Infinity Publishing; 2013.

4. Neumann A. The Good Death: An Exploration of Dying in America. Boston, MA: Beacon Press; 2016.