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.Many may have heard of the late Dr Elisabeth Kubler-Ross, 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

Anger

Bargaining

Depression

Acceptance

These psychological reactions can, and do, form a part of the dying process as do other emotions such as shock, disbelief, a sense of loss, hopelessness and helplessness as well as a search for meaning, and a sense of completion, as one moves towards a personal level of readiness for the end-of-life. Through my work, I have become aware that each person is unique in this process, and their emotional experiences differ not only with regard to what they experience but also in the intensity, duration, regularity and timing of these emotions. Some of these feelings occur simultaneously. They also occur within the context of anticipatory grief. The dying are acutely aware of current losses, such as the loss of health, mobility and independence but may well grieve future, anticipated losses, such as the loss of family, friends, a future and life itself. As with one’s personal journey through life, the end-of-life journey is unique. One’s end-of-life journey is a deeply personal process that is influenced, as I previously mentioned, by emotional, physical, social and spiritual forces. It involves shifts, changes, key personal experiences and decisive moments. It may also bring about positive, purposeful behaviour, breakthroughs and, potentially, transformation as well as a quality and fullness of living, within the limitations faced. The end-of-life journey is a time during 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, hope and peace to ease these fears and anxieties. There exists the opportunity to revisit one’s perception of, and relationship with death, in the understanding that dying is not death, it is the life before it. In this way, the end-of-life process involves choice; a choice about living life fully 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.