Teaching the Living About Dying
Why We Should Talk About It
Many adjectives describe the word "death". What images do you see or adjectives that come to mind when you hear the the word "death"?
| Adjectives that Describe Death | ||||
| Catastrophic | Black | Morbid | Negative | Avoidable |
| Dark | Curtains | Passing | Grave | Grim Reaper |
| Sleep | Silence | Pale Horse | Demise | Dissolution |
| Quietness | Terminal | Haggard | Expiration | Extinction |
| Macabre | Dreadful | Gruesome | Horrible | Cadaverous |
| Wasting | Ghastly | Annihilation | Grisly | Fatal |
| Ending | Lifeless | Corpselike | Skull & Bones | Strange |
The word "death" also provokes images in our mind. Many famous paintings and sculptures depict the artists' view of death.
Our ancestors accepted death as a part of living. Death was natural and accepted. They lived on farms where they saw death every day. They were often surrounded by death from accidents, wars, diseases, and epidemics.
Today, society conditions us to deny death by admiring youth and shunning the aging members. People now often die outside the home - in hospitals, nursing homes, and assisted living homes. Many have no experience with a loved one dying because we are so protected throughout life. We "protect" our children from experiences with death and in doing so continue the fear and the myths about death and dying. Unspoken fears, myths and superstitions have become the norm for today’s society. Many believe if we talk about it, it will happen.
What is Death?
Death is part of the cycle of life. Everything is born, grows, and dies: plants, animals, microbes, and humans. Death means different things to different people. Is it the body and or the spirit that dies? There is a hunger for wholeness of spirit. We need to learn about the cycle of life and accept that nothing is permanent. We honor the deceased and their spirit in many ways: funerals, obituaries, storytelling, memorial markers, cemetery visits with flowers and flags, tracing our lineage, naming stars, planting trees, building a shrine, and mourning. We can honor ourselves and live life fully by accepting that death is a natural part of the cycle of life.
Communication with Others
The feelings about death are many: curiosity, sadness, fear, pain, grief, guilt, and relief. We express those feelings in many ways: by crying, by laughing, by talking, by being quiet, by hugging the living, reviewing our life, and by reflecting on life’s meaning. It is not death we fear but the process of dying. Stephen Levine calls it the “fear of the uncontrollable unknown”. There are many ways to let others know it is OK to talk about death. Some ways are recalling the funeral of a loved one, reciting poetry, asking if they are scared, touching the dying person, and through art or music.
Values
Everyone has different values and different meanings for the values they hold. Learning what those values are is an important task of the living and the dying. Some values we hold are friendship, family, love, faith, possessions, health, clear mind, control, feelings, life, art, music, books, money, religion, work. Attitudes about death vary greatly and often relate to the person's spirituality and culture as well as their values. What are your values?
|
Values |
||||
| Family | Religion | Work | Freedom | Speaking |
| Friendship | Health | Food & Eating | Exercise | Independence |
| Culture | Volunteering | Arts and Crafts | Reading | Love |
| Clear Mind | Faith | Money | Possessions | Feelings |
| Music | Books | Stories of the Past | ||
Spiritual Aspects
Spirituality is the interconnectedness with self, other, nature, and/or a high power. Religion is a system of faith and worship. One can be spiritual WITHOUT subscribing to a particular religion or faith. Different religions have different beliefs and views of death. While it is important to keep in mind the beliefs of different religions, we must recognize each individual's beliefs are their own.
 |
Christianity – Belief in one God. Treatment is personal preference. Euthanasia and assisted suicide forbidden. Autopsy and organ transplant permitted. Confessions, repentance, and communion on death bed. |
|
Buddhism – Following the Eightfold Path leads to cessation of desire, which is the cause of all beings to suffer. Dying and death are inevitable. Maintaining consciousness is important. Want a quiet place for incense burning and chants. |
|
Hinduism – Goal is freedom of the soul from endless reincarnation with suffering. Prefer to die at home. Want resolution of personal matters. Expect suffering and could refuse therapeutic measures and pain medications. |
|
Judaism – Central belief in one God and following the Law and rituals. No preference for place of death, treatment. Euthanasia and assisted suicide forbidden. Need support and freedom to practice rituals of the Law. Strong family involvement in decisions. |
| Islam - Means surrender to One God. Prayer 5 times a day. Alms-giving, fasting. Friday is worship day. Dietary restrictions. Quick symptom relief expected. Dying rituals. After death, non-Muslins cannot touch body and funeral and burial quickly. |
Cultural Aspects
There are as many different views of death as there are cultures in the world. Some view death as the end of the body but not the soul. Others see death as the beginning of an afterlife. Other cultures see suffering as retribution for wrongs. Some cultures see death as a release from the burden of living. Still others believe in reincarnation and look forward to returning to life in another form.
There are many dimensions to culture beside race and ethnicity. All of these dimensions play a part in the decisions that a person makes regarding illness, care, and view of death. Culture affects one’s perceptions of end-of-life, afterlife, grieving, death, and healthcare choices. Some important differences are:
| Women by virtue of longevity as compared to men have more experience with illness and death. They are often the caregivers of the family member who is ill and dying. |
| In communication styles, some discussions must be directed to the male or female head of the family. |
| Pain perception varies with age. Elders expect pain, do not complain, or have fears of addiction. |
| Those with different physical or mental abilities may feel more alone or stigmatized. |
| Family members may be estranged from the dying person by differing sexual orientations. |
| Spirituality and religion may dictate particular rituals or choices for treatment and care. |
| Nearly 25% of families are devastated by the financial burdens of terminal illness and account for many bankruptcy filings in the U.S. |
| Those who are homeless have limited access to care and can be ostracized. |
Live This Year as if it is Your Last
Everyone should be living this year as if it is the last one we have. This involves a careful life review and reflection on our life. What could we have done differently? How can the wrongs be corrected? Examples of unfinished business are: to forgive and be forgiven; to repay debts – not just monetary ones; to seek reconciliation with family or friends; and to get the house in order. Not only is it important to do a life review but to work on that unfinished business now rather than later.
Communication
Many older adults still place health care providers high on a pedestal. It is hard for them to question what they say, go against their advice, or even ask for clarification of information. They may want curative or palliative care but are unable to tell the physician their wishes. Curative care is focused on curing the disease causing the illness. Palliative care is focused on whatever measures needed for comfort, dignity, and quality of life. We will present the five principles of palliative care in the "Cure to Comfort" Section.
Financial Concerns & Planning
Most people are unprepared for the financial burdens of illness or even of death. Many people do not even know their net worth. Some do not know what their retirement income will be other then from Social Security. Most do not know what their insurance. Medicare, or Medicaid pays for in healthcare because they have not encountered catastrophic illness. Consulting with an insurance agent or retirement planning consultant can be helpful in planning now for the unexpected tomorrow.
Today's Choices for Tomorrow
When we make choices, we gain control of the situation. Using advance directives, a person can make many choices and gain control regarding end-of-life decisions. The most important part of advance directives is communication with family members prior to completion to be sure they understand future wishes and desires for care if terminally ill. Some of the variables to consider are: (1) choosing intravenous or tube feedings, (2) use of antibiotics, (3) ventilation/respirator assistance, (4) use of complimentary or alternative medicine, (5) being transferred to hospital, to different town, or to a different state for care, and (6) benefits, risks, and costs of care.
Many do not have advance directives because they cannot talk with family or friends about desires at the end of life. Those that do not have advance directives place the burden of all decision-making on the family members during time of distress and crisis. The family may then be second-guessing the wishes and/or there is conflict between members on the course of action to take. Even with organ and tissue donation, the family makes the final decisions despite a person’s wishes.
Letter of Last Intent or Last Instructions
An important first step in preplanning for you death is a letter of last intent of last instructions. This includes a lot of personal information about you and your preferences regarding a funeral and burial. This is not a will. It is intended to be a guideline for family and friends. Having all the information in one place will relieve your family and friends from having to make many decisions during a time of grief.
