September 2016

About death and dying

One of the biggest gifts we can give one another is to honour and validate someone’s expression of suffering, be it physical, spiritual, emotional or a combination, and not judge or offer solutions about how they feel about it, writes Joanna Thyer.

BY Joanna Thyer

We can never truly understand another’s experience of dying, or understand what happens psychically, spiritually, physically and emotionally when a person is close to death. An incredibly subjective experience, we can only make guesses as to what being in that ‘twilight zone’ of hovering between life and death might actually be like.

When I worked in hospitals in a pastoral care and chaplaincy role for a decade, I noticed a variety of responses to death from people as they approached this inevitability. Sometimes I found that those with a strong religious background might fear death because of what they were taught about hell as a child. For others, it might be that they wanted to die because they felt they had become a burden to their families.

Exploring the emotional and social context of a person’s life is incredibly important for those working in pastoral and palliative care. In particular, aiming to discern: What really are the major concerns in this person’s life? What kind of death do they really want? Are they afraid of death? Or are they afraid of what comes after death?

As Moira Byrne Garton previously pointed out in the March edition of The Good Oil, euthanasia is an issue that can be extremely complex and subjective. Unlike physical suffering, the spiritual and emotional dimension of suffering may never be fully understood or communicated by a patient or loved one.

The search for peace is integral to being human and when patients find themselves at peace with God, they are more likely to be more at peace within themselves. I cannot tell you how many times as a pastoral carer I heard the phrase “I want to die”, by a terminally ill or critically ill patient. Yet in many of those situations I encountered, it was often existential suffering that was the biggest motivator of the statement “I want to die”, rather than direct physical suffering. Existential suffering can only be uncovered by deeply exploring someone’s feelings, fears, and apprehensions about their life – what it has meant, what it means now, and what they believe about what happens to us after death, and so on.

Another factor in the debate around euthanasia is that many people do not in fact really know what euthanasia is. Likewise, the loved ones of a dying person sometimes express fears that by not feeding a patient who is dying, that is hastening their death. This is incorrect. Stopping feeding and putting fluids into someone is not euthanasia, rather it can sometimes be appropriate care towards the end of life, when the body is not capable of absorbing nutrients.

I have often watched films where giving someone extra morphine is inferred to be euthanasia. Yet euthanasia is not giving someone continual doses of morphine or another drug to ease their pain before they die; euthanasia is giving someone a direct drug cocktail that will cause them to die as quickly and painlessly as possible.

This misunderstanding is often repeated time and time again by people who have never worked in healthcare and among pro-legalised euthanasia advocates, as if palliative care was not designed to ease people’s suffering.

Anyone possessing empathy can understand the feelings expressed by someone diagnosed with a chronic illness in later life, that they would rather ‘take a pill’ than be ‘non compos mentis’. These feelings need to be addressed on a case-by-case basis. Nowadays, thankfully Advance Care Directives and other measures can help people plan for potential eventualities – like not wishing to be kept alive unnecessarily by machines, and not wishing to be resuscitated in the event of heart attack under certain circumstances, or not having a condition like pneumonia treated when they are dying or close to the stage of dying.

Dr Karen Hitchcock, author of Dear Life, On Caring for the Elderly, points out that there is also another issue – that people can change their minds as they approach death and make different decisions about end-of-life care than they made a decade or more ago. They may decide they want to live on as long as possible for all sorts of reasons. These are very different scenarios to those presented by the push for legalised euthanasia.

One of the biggest gifts we can give one another is to honour and validate someone’s expression of suffering, be it physical, spiritual, emotional or a combination, and not judge or offer solutions about how they feel about it. Exploring their experience, through questions such as “How do you mean that?”, or “What is it that makes you feel that way?” – can help the person unpack their complex emotional reaction to what is going on for them at this point in their lives. It requires a non-judging attitude and supporting someone to find a way through those feelings, and not trying to ‘fix’ the emotional state at that moment of distress or despair – merely easing and acknowledging it.

One of the biggest lessons I learnt in all my years working in pastoral care, is that for those ministering to the elderly, the sick, the dying, it is crucial to meet the person ‘where they are at’ and not push our own religious, moral, ethical or cultural views onto that person; but rather, to discern what the things are that are important to a person in that situation, what sustains them, what concerns them, what are their fears around dying etc., and help them make choices that will lead to the best possible outcomes in what may well be a very difficult or traumatic situation.

As much as we might like to delude ourselves into the contrary, there are no guarantees in life – and none in death either. We might like to think we can choose how we die, and make necessary arrangements, but there may be times when that scenario plays out differently to what we might have imagined. Therein lies part of the mystery of life and death.

Joanna Thyer

Joanna Thyer is the author of the 2018 Lenten booklet, "Listening to the Wisdom of the Desert" (Garratt Publishing, 2017) and also "12 Steps to Spiritual Freedom" (Loyola Press, 2014). Both books are available from Garratt Publishing and major book stores. Joanna is also a university multi-faith chaplaincy coordinator and a coordinator of a community program for people living with HIV-AIDS.

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