Healthcare Perspectives - Death and Dying
Death is a certainty in life every human being will face. The range of beliefs about death is broad as we explore the structures of different cultures, religions, and individual households. Regardless of your view about death and the dying process, dealing with our own death or the death of friends, loved ones and members of our communities brings thoughts, feelings and spiritual inquiry to a different level.
Within the healthcare world, when we refer to death and dying, we can be referring to anything from the well know hospice and palliative care, to the ongoing debate around euthanasia, graceful aging, or to the internal journey the dying process takes us on as we bare witness to this inevitability. For many of us, our mortality or the potential of death plays a profound role in the way we live our lives.
Death has a powerful ability to provoke questions such as:
- How does our view of death change how we live?
- How does the way others embrace our death help us face it ourselves?
- How do we make sense of so many different traditions and belief systems about death and the idea of the afterlife?
- Why do we fear death and how do we learn to embrace this natural and inevitable moment?
As thinking and feeling beings, death is one of those things that commands we take a moment to reflect, and can often be an inspiration for great healing on less obvious levels. For many, healing doesn’t always take the form of a “cure.” Actually, preconceptions of what “healing” is, can often fight the natural dying process. Healing can simply mean that we find acceptance of a situation or that we find peace in our hearts while embracing our own mortality or the dying process of a loved one. The presence of Death or the dying process can often be a trigger for heightened emotional and spiritual states. This increased sensitivity can awaken insight that trickles down into healing on levels of our consciousness that prove life can come from death.
Paul Tillich wrote, "It is man only who is able to face his death consciously; that belongs to his greatness and dignity."
And yet, we face the reality that our bodies will not last forever and our time on earth will come to an end. In these final moments of our lives it is comforting to know that there are healthcare institutions established to facilitate this transition in a loving and caring way. A very important decision when faced with terminal illness and/or the dying process is whether we prefer home, hospice or a hospital setting for our care.
The modern hospice movement grew out of the work of British physician Cicely Saunders with dying patients in the late 1940s. Saunders opened St. Christopher's Hospice in London in 1967 as a teaching and research facility dedicated to the physical, emotional and spiritual care of the dying. St. Christopher's organized a team approach to professional caregiving, and was the first program to use modern pain management techniques to compassionately care for the dying. Hospice spread to the U.S. and other countries and with it the new field of palliative medicine, also called comfort care.
Having now become a philosophy of care more than a place of care, the focus of hospice care evolves from the view that every individual has the right to die pain-free and with dignity, and that their loved ones will receive the necessary support to allow them to do so. The focus is on caring, not curing and in most cases, care is provided to people in their own homes. Hospice programs differ substantially in the services they readily provide and in the interdisciplinary treatments and devices they support and use. Hospice can be provided in freestanding hospice facilities, hospitals, and nursing homes and other long-term care facilities. Hospice care is available to persons of any age, religion or race and depends on the needs and wishes of patients and family members, financial considerations and local availability
The philosophies of hospice and palliative care are identical having been born from the same compassionate focus on quality of life, symptom control, patient and family as the unit of care and interdisciplinary treatment. However, there are major differences of reimbursement, eligibility for services and care settings. Developing palliative care programs generally address the physical, psychosocial, and spiritual needs and expectations of people with life-threatening illnesses at any time during that life-threatening illness, even if their life expectancies extend to years. Although the focus intensifies at the end of life, the core issues of relief of suffering and improvement of quality of life are sustained throughout the course of the illness. Hospice focuses on relieving symptoms and supporting patients, and their families, with a life expectancy of months not years. Palliative care may be given at any time during a patient’s illness, from diagnosis on. Palliative care and hospice often work together, helping people and their families on their journey through a challenging transition of life.
As compassionate as attempts are at easing and curing the suffering of those with terminal illness or providing the most comforting environment for someone’s natural departure at the end of their life, there arises the circumstance of an individual to make the time of their death their own choice regardless of the good intentions and views of others. The decision to end one's life when death is approaching anyway is sometimes called self-deliverance, rational suicide, physician-assisted suicide (PAS), or voluntary euthanasia. The "right to die" is the subject of controversial legal battles on an international scale.
Facing death and loss in any circumstance, no matter how painful or challenging, can be experienced as a tremendous opportunity for growth and learning which actually enriches our lives. Many people who are facing death describe this time in their lives as a period when they feel most in touch with their true sense of meaning and purpose. In seeing the inherent grace of both birth and death we can recognize the preciousness of life itself and appreciate each day as a gift. In the end, the question we can ask is, how can we use death and the dying process to help guide us into more fully living…even if we’re dying?
Healing Modalities within Death and Dying
- Religious Perspective
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