They say the only certain things in this life are death and taxes. Death is a guarantee at the moment of birth and becomes ironically part of living itself. It plays a key role in our life span in this temporal world. Yet, it is the most feared and avoided topic despite its central importance to our life itself. Thanatology attempts to understand the nature of death and dying itself and attempts to explain the science and philosophy of death. Grief Counseling tries to help us adjust to the process of dying or the death of another. Together, they can help an individual better discuss, deal and cope with this very natural life event.
Traditionally, death has many characteristics. Lack of respiration, lack of pulse and heartbeat, zero response to stimuli, lowered body temperature, stiffness of the body and bodily bloating are all signs of death. The Harvard Criteria lists death as something that leaves the individual unresponsive to stimuli, no movement or breathing and no reflexes. Furthermore it notes that there is no longer any circulation of blood to the brain and a flat EEG exists.
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Death hence has it characteristics and permanence once a certain time period of such lack of activity exists. While the fear of not being dead and buried may have existed long ago, today’s science clearly delineates the boundaries of alive and dead. Death though is more than a physical event, but is also for many a spiritual event. It is an event that leads to a new birth in spiritual beliefs and is more than just merely the end of physical activity. While spirituality and death may not have empirical evidence to support it, the belief itself is wide held throughout humanity. It can also be said, while it cannot be empirically proven, life after death, it is also said it cannot be disproven.
The dying process leads to death and is more than a physical journey but also a spiritual and emotional one for the dying as well as their loved ones. The biggest question to ask is when does dying begin? Philosophically one can say, dying begins the day we are born, but health studies require a more definitive definition that denotes a direct and acute movement towards death itself. While one may be dying, sometimes, one may not even know the event is occurring. This is why recognition of the facts is essential to officially declare one is dying. The facts need to be communicated and realized for the psychological, emotional and spiritual elements to enter into the equation. When nothing else can be done to prevent the acute event, one officially realizes they are dying and will die due to a particular thing.
The expression and communication of dying to another is something that healthcare professionals have recently been hoping to improve in regards to delivery of the news. In the past, the dreaded news has been expressed coldly and sometimes abruptly. As an event of failure to the medical world, the person was left to process the information without guidance or compassion. Today, those in Pastoral Thanatology, look to help the dying die with dignity but also understanding and compassion. Hospice prepares the dying for the ultimate end, looking to reduce pain and prepare one emotionally and spiritually for death.
Physicians and healthcare providers though can better communicate death to their patients. Sharing smaller facts and gauging responses are key, as well, and not overwhelming the dying and their family at first. Explanations and time to educate are key, despite the discomfort of such bad news. Allowing pauses and questions and time to process is key, but also respecting denial. Being there and giving the time is key. Another important element is not to stretch the truth, but to be completely honest, but in that honesty, again, find the time to listen and not mechanically leave the scene after such heartbreaking news. Many healthcare professionals are not trained in explaining death and are only trained in the mechanics of what is occurring physically, while dismissing the emotional and mental aspects of death.
Once one is faced with dying and accepts the outcome, certain questions become obvious to the dying. Certain trajectories manifest to the dying that map out their final days. The biggest are certainty and time. How long does one have and what to expect in the final months, days or hours. Some trajectories are quick, others linger, and others occur unexpectedly. These aspects can greatly change how one prepares for death.
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Obviously each trajectory has their benefits and disadvantages. Preparation in death can allow one to put all business aside, but leaves one to the mental long anguish of knowing the end is coming. Quick deaths can reduce this anxiety but leave one with very little time to prepare financially, spiritually and emotionally.
The long mental process of accepting death was best laid out by Elisabeth Kubler Ross. Kubler Ross worked with the dying and found they responded in a five stages to death. Namely, denial, anger, sadness, bargaining and acceptance. Each phase while not always ordered, showed the emotional response of most people to the news of death itself. The news can be so terrifying that one may react in a variety of ways trying to control what one cannot control. The ultimate end is acceptance because death is guaranteed for all.
Charles Corr also pointed out the reaction to the news of death. At the epicenter is the physical reality of dying, followed by the psychological reaction, followed by the social reactions and finally the spiritual reactions. As the wave of the news spreads, the dying story encompasses all aspects of the person’s existence.
Buddhist stages of death are more spiritual. They see various stages of loss of sensation, to visions, to nothingness itself. In Christianity, death is seen as the result of sin. It is a punishment and the severing of soul and body, but it is temporary, and the body one day is restored to the soul. It is important to understand the spirituality of the individual who is dying and to help them fulfill any incomplete spiritual exercises before death. This gives comfort to the dying.
How death eventually takes the person is something very intimate and seen by family and healthcare workers. While it can be painful, it is sometimes very peaceful, as the body surrenders to death. While many may never have it, it is everyone’s hope to experience a happy and peaceful death surrounded by love. This is the most anyone can ask for as this dreaded but important part of our life occurs. One needs to be prepared and think about this event. It should not be disregarded as morbid, but seen as an important part of life. The thought of dying well is something we should all smile towards when that day comes.
If you would like to learn more about Grief Counseling and Pastoral Thanatology, then please review AIHCP’s Grief Counseling Certification and Pastoral Thanatology Certification. The programs are online and independent study and open to qualified professionals seeking four year certifications in these disciplines.
Please also review
“Death, Dying and Human Society”by David Kastenbaum
“On Death and Dying” by Elisabeth Kubler Ross