FACING THE END-OF-LIFE
Turning to face the end of one’s life, whether this is imminent or a focus of one’s contemplation, raises several challenges. These challenges are a complex mix of one’s thoughts and emotions, relationships with others, spiritual philosophy, physiological well-being, as well as practical considerations. Turning to face the end of one’s life is the beginning of a journey; a journey that is as much a part of life as one’s birth, and a journey that is as natural as the cycles of the seasons. As human beings, however, our sense of self, and our ability to reflect on our own mortality and circumstances, makes this journey difficult.
Reflecting on the dying process can highlight personal fears and anxieties, some of which may involve uncertainty around what happens as one nears the end-of-life. The process of dying, which we will all face one day, can best be nourished through self-preparation, self-exploration and through a personal understanding of what death means. Ultimately, It is about an acceptance of one’s mortality.
For those nearing the end-of-life, many issues may come into focus; issues such as a sense of not having said all that needs to be said to a loved one, an unfulfilled ambition or a personal regret. For the dying, fears and uncertainties, regrets and concerns exist within a context of physical change; physical change that demands the navigation of the unfamiliar, whilst facing an ongoing sense of inevitability. Many of these fears and uncertainties are influenced by one’s beliefs, such as beliefs surrounding one’s ability to cope or the level of support available. They also exist within the context of one’s spiritual or religious beliefs.
In the West, medical protocol is geared towards saving lives rather than enabling people to die well. When needed, however, medical advances do ensure that pain and overwhelming suffering can be alleviated when nearing the end-of-life. This is of real comfort and is very reassuring, but there is more to this uniquely personal and complex journey.
The late Dr Elisabeth Kubler-Ross is a world-renowned psychiatrist who, in 1999, was named by Time magazine as one of the “100 Most Important Thinkers” of the past century. Kubler-Ross theorised that those who are dying potentially experience five psychological stages of loss and grief. These stages are:
• Denial: On learning of the inevitability of their death, a person’s initial reaction may well be one of shock and disbelief, of “No, not me! This can’t be happening to me.” Although this denial is seldom absolute, denial and disbelief is the most common response when someone is informed of the seriousness of their illness. • Anger: In this stage the dying person expresses anger, rage, resentment and hostility at the “injustice” of dying. The reaction shifts from “Not me” to “Why me.” This anger may be displaced and projected onto others including, for example, family members, medical professionals and God. • Bargaining: Here the individual shifts into “making deals” to prolong life, which includes bargaining with, and making promises to God. Bargaining is an attempt to postpone death, and usually involves a change in behaviour or a specific promise in exchange for additional time to live. • Depression: When the dying person’s physical condition weakens, and anger and bargaining have failed to bring the desired results, the individual may become overwhelmed with feelings of loss, hopelessness and helplessness. The dying person can no longer deny the inevitability of death. The question asked now becomes “What is the use? What is the point?” Depression may be linked to both current and anticipatory issues. Current issues include that which is already lost, such as health, mobility, independence, the ability to meet responsibilities, and unfulfilled ambitions. Anticipatory issues include the coming loss of one’s family and friends, one’s future and life itself. This is referred to as preparatory grief. • Acceptance: In the final stage one comes to terms with, and accepts, death. This is not to suggest that this is a “happy” acceptance but rather a resignation to it. This sense of acceptance may be somewhat void of emotion, other than the feeling of readiness to meet the end-of-life.These psychological reactions are fundamental to loss, grief, and the process of dying. Through my work, however, I am aware that not everyone experiences each of these stages or responses. Nor are these reactions necessarily experienced in the order in which they have been given. Furthermore, the dying person can move back and forth through these stages more than once, or experience more than one stage simultaneously. I believe that, as with one’s journey through life, the end-of-life journey is a unique and personal experience. My approach is that the end-of-life journey is an individualised and deep process in which one can be supported to experience a quality and fullness of living, within the limitations faced. It is a time in which precious opportunities should be seized, a sense of the “completion of life” can be experienced, and in which an opening to profound moments is possible. It is a journey that allows one to face fear and uncertainty, and through love, acceptance and peace to ease these fears and anxieties. It is about revisiting one’s perception of, and relationship with death. In this way, this journey is about living life in the context of one’s physiological condition, and choosing that which brings meaning, richness and value into this time of life, moment by moment.
It is about living well now, in this moment, and ultimately, dying gently.