Chapter 46: Death with Dignity
|I am not going to fight against death but for life.
- Norbert Segard.
Death is still a taboo topic - one most people dont like to talk about - which is surprising, since it is one of lifes certainties. However, it is an extremely uncomfortable subject to discuss, which is why most of us continue to pretend that it doesnt exist ! However, being prepared for death can help considerably in dealing with it from a pragmatic viewpoint.
Most doctors, too, are uncomfortable with death, which is why they often cannot cope with a patient who is dying. Many doctors still look upon death as a defeat since they are taught to treat death as the enemy. This is an unfortunate point of view and we need to change our attitudes! Death is simply a part of the cycle of life: it is not the opposite of life, it is the opposite of birth.
When faced with our own mortality, all of us react in different ways. Most people, however, hope for a good death, for a death with dignity, however they may define it. Its therefore important for a person to express his or her preferences regarding the degree and the type of medical care he or she wishes to receive at the terminal stage of his or her life. Such preferences can be expressed through formal legal documents called advance directives. Such documents record legally your wish to choose or refuse certain forms of medical treatment.
There are two types of advance directives:
Deaths closest companion is grief, and the term anticipatory grief refers to the feelings of loss and sadness which can arise during terminal care. It is helpful to remember that many people go through five stages of grieving when dealing with a terminal illness. As described by Elizabeth Kubler-Ross author of the famous book, on Death and Dying, these stages are as follows:
There are different forms of caregiving available for the dying person. Many people who are terminally ill choose to remain at home or stay in a home-like place, such as a hospice, rather than a hospital. Many people fall victim to the anxiety that if they become seriously ill, modern medical technology will not restore health but simply prolong the agonising process of dying. Therefore, their decision to stay out of a hospital is closely connected with their desire to achieve death with dignity. A key objective in hospice and home care is to obtain high-quality palliative care to control pain and preserve the highest possible quality of life as long as the patient is alive. Since it takes some time for hospice professionals to tailor palliative care and pain management to suit each individual, it is best to begin some level of professional care before a crisis actually arises.
Palliative care, also called comfort care, is primarily directed at providing relief to a terminally ill person through symptom management and pain management. The objective is not to cure, but to provide maximum comfort to the patient and maintain the highest possible quality of life for as long as the patient is alive. Well-rounded palliative care programmes also address mental health requirements as well as spiritual needs. The focus is subtly shifted from death to compassionate specialized care for the living.
Palliative care uses an interdisciplinary team model (consisting of doctors, nurses and priests) that provides support for the dying person and those who are companions in his journey. It cannot be stressed enough that top-quality palliative care can make the difference between a gentle death and one in which suffering is so terrible and prolonged that assisted suicide becomes an attractive alternative. Death care is an essential part of medical care, but it remains a neglected area today; we still dont have deathologists!
Pain management is one of the most important aspects of care for terminally ill persons. Aggressive pain management forms a specialized topic of medicine, and a specialist opinion can be helpful if the doctor treating a particular patient seems unable or unwilling to provide adequate pain management. Most doctors still use pain medication for dying patients very frugally. Such an approach is antiquated, and with the remarkable advance in medicine and technology, it should be possible to keep any patient comfortable during his final stages.
The decision to end ones life when death is approaching anyway is variously called self-deliverance, rational suicide, physician-assisted suicide (PAS), or voluntary euthanasia. An individuals right to die is presently the subject of controversial legal battles on an international scale.
LIVING AFTER DEATH
At present, given the miraculous technique of organ transplant, death does not mark an end by itself; you can continue living even after your death! Merely filling out a donor card is not enough; the most important step is to convince your family members about your wishes. It is indeed a hard topic to bring up because most people dont want to think about the deaths of their loved ones. However, it is important that you talk about your decision right away! If anything adverse happens to you, doctors will have to turn to your family for permission - even if you have signed a donor card - in order to use your organs to save another persons life. If your family doesnt approve of your decision, you can appoint a lawyer to put your request in writing. You should, nevertheless, remember that even with legal documents, doctors will honor your familys wishes. The good news is that families which have discussed organ donation are more prepared to make a positive decision and are more likely to follow your wishes.
THE ROLE OF RELATIVES AND FRIENDS
Watching a loved one die can be a very painful process, and the deteriorating condition of the dying person also forces you to confront your own mortality. Families can become isolated from social networks as they struggle to care for a dying loved one, and stress can break down close relationships. A patients inability to take care of himself often causes guilt, shame or irritation, and physical changes also affect their self-esteem. Some families will find comfort in knowing that they are experiencing normal responses, and some may require counseling to help them cope.
Often times, in order to do everything humanly possible to prevent death from snatching away a loved one people sometimes resort to heroic and desperate medical measures. Such measures simply add to the patients burden, while providing little solace. At some point of time, you need to be able to let go - and to respect the sinking persons wishes to die with dignity. Often the familiar bed at home is a far better place to die than an impersonal and cold hospital room.
After a person dies, often a number of formalities need to be taken care of. You will need to get a death certificate, or think of getting a postmortem (autopsy) done, in case doubts about the cause of death persist. Organ donation can be hard to think about at this time, but this is the only time to do so. You need to remember that your generosity can help another individual greatly.
After the death of a love one, you need to allow yourself to grieve, so that you can continue to live, and there are many social support mechanisms to help you to do so. Remember that grief heals best when you share it with others !