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 or religious beliefs, 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 death. Ultimately, it is about an acceptance of one’s mortality.
For those nearing the end of life certain issues may come into focus; issues such as a sense of not having said all that needs to be said to a loved one, the need to forgive oneself and others, 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. These fears and uncertainties also exist within the context of personal beliefs surrounding one’s ability to cope.
A dying person’s level of comfort is influenced by access to medical care generally, as well as to palliative care and hospice care when appropriate. For those who choose to face the end of their life at home, knowing that comfort care is available to them, including assistance in the alleviation of any physical pain or psychological distress, is important. The knowledge that, if needed, medical advances can ensure the management of pain and suffering when one is nearing the end of life is 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: