The dying have many needs that are sometimes neglected. Physicians focus so many times on physical needs. They see sometimes patients as success or failure only. Dying is not failure but a process. Properly dying is part of living.
The dying face many issues when confronted with death and beyond the basic issues of human dignity and physical comfort, they also need emotional, mental and spiritual support. When these things are not met, then the entirety of the human person and his or her needs are neglected. Important parts of one’s life are neglected when fear and death encompass the person and the family. The video below explores the multiple needs of the dying.
Please also review AIHCP’s Pastoral Thanatology Program and see if it meets your academic and professional goals. The program is online and independent study and open to qualified professionals seeking a four year certification in Pastoral Thanatology
Upon a worrisome visit to the doctor, eventually in one’s life, one will come to the grips of existential crisis, where one must deal with a life or death illness, or hear the terrifying words, that one is dying. For some, these words come earlier in life, for many, later, and for some, death can come like a thief in the night. Those who are granted the ominous warning are given a blessing and a curse. A blessing to prepare oneself and others, to put things right and affairs in order, but also a curse in knowing the clock is fearfully clicking to a deadline that is unavoidable.
There is a myriad of emotions and feelings that one goes through when a terminal illness is announced. An existential reality of one’s own finite nature is made rawly known to the intellect. What was once considered an abstract but real concept suddenly becomes personal and intimate. One comes to the conclusion that death will concretely and definitely happen. It is no longer a future imaging of how but becomes a concrete concept of now and here.
How one perceives life and existence itself plays a large role in the existential dread of this bad news. Levels of fear and anxiety are measured and varied in regards to one’s own existential beliefs. Someone who is profoundly convinced of life after death and molded by an undying faith, may feel a sense of fear, but also a sense of hope and reward, while one who holds empiric and only observable phenomenon as a basis for existence, may feel a deeper dread of creeping into nothingness. Some individuals are less attached to the temporal reality and are able to sense a stronger sense of purpose and peace beyond the observable world. Those of this deeper faith, whether rightly placed or not, will react quite differently to the bad news of approaching death than one of lesser or no faith.
Fear of the unknown still exists even if in the smallest grain to the faithful. So naturally, the evolutionary push to exist when challenged will spring forth within the soul a type of fear. The fear of the unknown still exists for those of faith, but the levels of fear that may surround one who is terminally ill, differs greatly in intensity. One of faith upon the announcement of bad news will definitely still feel a sense of fear and be forced to reckon with the unknowable. This type of fear is a natural reaction. Since one’s conception, the urge to exist is programmed within the body. The urge remains a strong driving force.
For those facing death, a general fear may also be replaced with a more acute fear of the now. Fear of sharing this news, or keeping it to oneself. Fear of the disease itself and what this particular disease may do to one’s body during the final phases. Oneself may fear the pain, the treatments, the side effects and quality of life or even the fear of leaving family and children without one’s guidance and protection. Obviously these are grounded fears to one who has come to a firm acceptance. While initially one may be swarmed with questions and options, one may soon find oneself consumed with collecting as much information about the disease or condition, understanding pain management or reviewing various extraordinary measures to preserve life. Understanding the enemy can sometimes qualm some fear and even give a glimpse of hope. One finds oneself with more power over fear when one faces the enemy across oneself. Some individuals face the enemy, while others choose to live in fear and hide from it. One in the end accepts how they will face death, either with a strong will, or a broken one. Accepting death but facing it with a strong will despite fear is the true definition of courage.
Due to this natural fear of death, even among the most spiritual and religious, one when faced with this terrible thought will undoubtedly deny it. Elisabeth Kubler Ross who worked with the terminally ill observed this natural human reaction to reject bad news initially. Something so frightful at first refuses to be processed by the brain. Bad news is met with an equally powerful rejection of it. As one receives this bad news then, one will probably initially reject the sentence of death. How long this reality takes to sink in may differ among some. Some may seek additional medical opinions, until all options are removed. Others will proceed with elaborate alternative therapies in hope of a cure. For some, hope can be a evolutionary device for survival. It definitely is not something to rejected but when hope blinds oneself to such an extent that is masquerading as denial, then it can become problematic to oneself and prevent oneself from dealing with the reality of death.
Death itself is a process that many run and flee from. Evolution to survive engrains this feeling into oneself. Yet, if one stops and realizes that death is a process one must face, then maybe one can allow oneself the process of dying properly. Many cultures value a good death. A good death is as part of life as birth. Dying well, handling oneself well and maintaining dignity is critical to the last chapter. Long term denial strips one the opportunity to handle affairs, repair relations, prepare the mind body and soul and live the final chapters. So, absolutely, upon terminal diagnosis, one will feel fear and denial and this is OK. What one does not wish to continue to entertain is a long term denial. Hope should not be squashed, but denial should not be masked as hope either.
Oneself may think if one ignores the horrible diagnosis that it will go away. For this reason alone many in denial, may keep a terminal diagnosis as a secret from friends and family. One will ignore checkups and important procedures and postpone wills and other critical business at hand. These types of secrets are part of denial at its core. Oneself may feel as if one is sparing others grief, but this type of internalization of bad news only denies the reality and creates less time for others to express love and accept reality.
Following this diagnosis, other emotions may erupt within oneself. As Kubler Ross points out in her famous stages of grief, one experiences far more than denial upon the initial announcement of bad news. One will experience also a range of emotions with the first minutes or days or weeks or months. Anger is a powerful emotion that may erupt. One may find oneself angry at God, or others. One may feel one’s life has been stolen or cut short. Others may become jealous of others who were granted better health. Again, in grief, one cannot deny these initial feelings, but understand them and see where this anger comes from. While one may feel like they may be treated unfairly, one cannot allow anger to turn into envy and become caustic within one’s very being. There is little time left with a terminal illness and negative emotions and negative energies while acknowledged should not be permitted to fester, unless one wishes for the soul to also suffer with the body.
With the lamenting of death, some will feel greater melancholy. How long one grieves the impending loss of life, like fear itself, varies upon the spiritual nature and resilient nature of oneself. One should clearly come into contact with the sadness of loss of one’s physical life, but again, like anger, it is important to evaluate the emotion within its proper degree. Some may go into a deep depression or no longer wish to live. Oneself may recede to the shadows well before the date of death. When sadness of this level overtakes oneself, then one must realize that the diagnosis is now taking more life than it originally took before. The intense grief is taking what is left. It is stealing the final days of sunshine, family memories and expression of love.
With such deep emotions, sometimes it may be good to express these feelings. Some may find solace in their family and friends, but others may feel a fear to cause them more pain. While this is noble, in many ways, family and friends wish to help one carry this cross. Oneself should not feel isolated to the point where one has none to share the fear and emotions of dying. An additional option is finding others in support groups or other social venues where others of like diagnosis can meet and share emotional fears and acute physical symptoms. A good balance between sharing with family and other like diagnosed individuals can play a great tool in helping one face the emotions of one’s diagnosis.
Kubler Ross pointed out that many may also bargain. As if one has a final say with the grim reaper, oneself may feel the need to negotiate with the angel of death. This sense of powerlessness is lessened with bargaining and creates an illusion as if oneself can negotiate the final days. Oneself may ask, if I can only have an extra year, or have only this procedure instead the other procedures. This illusion of power and control over death is merely another way oneself may try to create one’s own ending. Instead of focusing on “ifs”, oneself should focus on the realities and what can be done within the time given. Less time bargaining and more time doing is a far better way to accept the angel of death.
Upon this terrifying news of one’s own impending death, one can react in a multitude of ways, intellectually and emotionally, but while no emotion is initially to be ignored, there is clearly a better way to face death. It is up to you, the person facing the terminal illness, how you will face the final chapter in your life and no-one else but you can author that chapter.
If you would like to learn more about death and dying, or about AIHCP’s certification programs in Grief Counseling and Pastoral Thanatology, then please review AIHCP’s online programs. The Grief Counseling Certification and Pastoral Thanatology Certification Programs are both online and independent study and open to qualified professionals seeking a four year certification.
Elizabeth Kubler Ross Stages of Dying. Please click here
Near Death Experiences are a universal phenomenon throughout the world. No culture is void of their presence. What does it mean? Is there a scientific explanation or is it a metaphysical experience?
Please also review AIHCP’s Pastoral Thanatology Certification as well as AIHCP’s Grief Counseling Certification. The programs are online and independent study and open to qualified professionals seeking a four year certification.
Death and dying is part of life and living. Living well means also dying well. How one philosophically, mentally, emotionally and physically approaches the topic of death is critical to one’s final days. Dying can be very unique for different people. It can occur quickly or slowly but for all it will come and how we approach it and understand it is not only important for oneself but also our loved ones.
Please also review AIHCP’s Pastoral Thantology Program and see if it meets your academic and professional goals. The program is online and independent study and open to individuals and qualified professionals interested in Pastoral Thanatology.
Spirituality is part of everyone. The whole person, mental and physical. While spirituality is more individual than social, many doctors do not give the holistic care to the entire being of the patient. Doctor sometimes focus more on the body, recovery and failure based on life or death. Many times the pastoral and spiritual issues are not identified. The patient has multiple needs and even for the non religious, many have spiritual needs or at least spiritual acknowledgement during grief and loss during care.
The article, “Does spirituality belong at the doctor’s office?” by Jen Rose Smith takes a closer look for the need of pastoral and spiritual care of patients. She states,
“In fact, many patients would like to discuss spiritual matters with their health care providers: One study found that 83% of patients want physicians to ask about their spiritual beliefs, especially when they’re facing life-threatening illness, serious medical conditions and bereavement. “A high percentage of people, if they’re in the hospital for a physical illness, would like to talk to their physician about spiritual matters and have a conversation,” said Dr. John Graham, president and CEO of the Institute for Spirituality and Health at the Texas Medical Center, a cosponsor of this month’s conference.”
Please also review AIHCP’s Pastoral Thanatology Certification and see if it meets your academic and professional goals. The program is online and independent study and open to qualified professionals seeking a four year certification in Pastoral Thanatology
Some may question spirituality with a physician or in healthcare but when treating the totality of the person there is always some type of spirituality. Healthcare professionals should not cross certain boundaries with personal faith but many individuals have spiritual needs and emotional pains. It is important to be more holistic in treatment approach of the entire person.
The article, “Does spirituality belong at the doctor’s office?” by Jen Rose Smith looks closer at the issue of spirituality and the doctor’s office. She states,
“Graham has defined spirituality as “our innate ability to connect — to connect to others, to our environment, to the transcendent mystery and to our true, deepest self.” Like Sweet, he said modern medicine’s focus on efficiency leaves out that broader view of patients’ well-being and their spiritual and religious needs during illness.”
Many physicians and healthcare professionals struggle with the basic interaction beyond the medicine and hence miss the spiritual needs of their patients.
Please also review AIHCP’s Pastoral Thanatology Program and see if it meets your academic and professional goals. The program is online and independent study and open to qualified professionals seeking a four year certification in Pastoral Thanatology.
Near Death Experience or NDE are mysterious and empirically unexplainable experiences individuals near death can experience. It is still a mystery as to if NDE is a proof for a metaphysical afterlife or a lack of current understanding of the brain and its unknown processes when responding to possible death. For now, they are accepted as something that is unexplainable and not to be connected with psychosis or any type of mental pathology but a legitimate experience some individuals face when dealing with death.
Near Death Experience or NDE has certain qualities associated with it that differentiate it from other mental states such as dreams or hallucinations. It NDE, there is an out of body experience that occurs, or a autoscopic episode. This episode is when one is unconscious and the trajectory if not corrected will lead to physical death. During this unconscious state, one can experience lucid visions outside one body. To qualify as an NDE, a 16 question survey must score at least a 7 in value.
Among the many questions include the level of consciousness one felt during the episode. Was the experience equal or greater than normal conscious behavior. This is a key element in differentiating from a dream state or a hallucination. During these states, individuals under anesthesia are able to comprehend things around their unconscious body that the brain should not be able to sense. This type of mental ability questions whether the soul is experiencing a metaphysical experience or if there is some unknown power of the brain yet known to science. Many who experience NDE are able to relate things regarding those around them while they were unconscious that the brain should not be able to observe or sense. In fact, the senses are even more acute and sharp during NDE. Blind individuals are able to see things in some studies, as well as individuals who can see but see more so in deeper colors and understanding than any mere human eyes. In other cases, NDE patients also understood the thoughts of others around them.
Science looks to explain some of these feelings and sensations when the body is in crisis. Russel Noyes, a famous psychiatrist, who researched NDE, pointed out that the body when in crisis experiences various adaptations. There is a sharp mystical awakening to more vivid images, as well as a depersonalization with emotion and a detachment. Also, there is a hyper-alertness with sharper vision and hearing that helps the person survive. Could these abilities be amplified near death?
Most who experience NDE, which is around 1/3rd who have close clashes with death, firmly believe it was a real experience. They return in many cases more peaceful and guided. They look to implement life changes and have less death anxiety itself. The experiences are also multi-cultural and do not differ between Western and Eastern religious codes. Even children with little predisposed religious ideals, experience the same and often beyond their natural understanding. Individuals who are not religious also share similar experiences.
During these religious experiences, many experience a calm and bright light, and in some cases see lost loved ones but others can experience nothingness or more frightful visions. Some see torture and hellish images. They experience upon their return a call for conversion or a scared traumatic response. Others try to explain it away.
Grief Counselors, or more so licensed professional counselors are needed to help individuals discuss and resolve their NDE experience. It is important that the counselor understand that it is not a pathology but to be on the look out for pathological reactions to the experience. Counselors also must be open to the individuals interpretation. Since there is no rational explanation, it may very well be metaphysical or also tied to unexplainable brain functioning that is firing off an array of visions that science cannot understand. It is critical to listen and accept the story of the individual with an NDR and how it relates to that particular individual.
Gaining the trust is key. Individuals, may think they are crazy, or noone will believe their story. It is important to reassure the patient that this is phenomenon is a real experience although unexplainable by science and that their visions are not crazy or pathological. It is essential to help the individual integrate the experience into their life story. Unless pathological reactions occur when extreme anxiety or dangerous new behaviors arise, the person should be encouraged to share and incorporate the experience into their life in a healthy way. There is no treatment since it is not a pathology itself and there is no true medication because the incident is beyond comprehension.
Those of belief may accept the experience as a religious experience. This is not pathological but acceptable. The reality is it may very well be a metaphysical experience beyond the scope of science and to marginalize it and categorize it against the will of the patient is counter productive. It is best to co-exist with the experience from wherever it came and allow it produce the healthy changes one needs in one life. Ultimately, there may be an explanation or it may be metaphysical, or it may be a mixture of both, but since they are universal and non pathological, it would be prudent to merely care more about how one reacts to the experience in counseling than to define it for the patient. How the patient defines it is the patient’s choice.
Death and dying is a mystery. It is the final chapter of observable existence. NDE is merely another element of it and how we see death beyond the grave and the many spiritual questions that burn within our mind and how our body reacts to death itself.
Please also review AIHCP’s Grief Counseling Certification and see if it meets your academic and professional goals. The program is online and independent study and open to qualified professionals seeking a four year certification in Grief Counseling.
Death is such a feared subject that many families put off discussing it. This prevents communication that can enhance closeness as well as clear miscommunication and heal old wounds. Beyond the fear of death, discussing or thinking about the “what if” is even more dangerous if anyone neglects putting their wishes on paper if they die or if they are injured long term. This can not only lead to a disregard of one’s wishes but also lead to multiple assets being misused or lost.
Everyone should have a Will, a Living Will and Power of Attorney document. Like insurance, it does not mean one anticipates the worst, it merely means one is prepared for the worst. When such documents are not prepared, after death, ensuing chaos can occur with bills, inheritance battles, state interference and overall bitterness. Likewise, when someone is very sick, on a ventilator, a feeding tube, or in a coma, one’s wishes may or not be met. A legal bind document can resolve these issues and ensure that what one wishes is properly handled.
There are three basic documents that ensure a calm legal atmosphere after death, or during a dying phase or possible long term illness. The first is the Final Will and Testament. This document ensures that one’s financial and legal business is resolved according to one’s wishes after death. It first gives an individual the power to resolve all financial and legal issues in your name. This individual is your personal representative and ensures that all expenses of funeral, bills and debts are paid immediately following death. Utilization of existing funds as well as life insurance are used to pay off any debts. This individual also ensures sell of property and transfer of inheritance and fulfillment of any final wishes. Also extremely important are one’s final wishes at the funeral and how the body is to be respected, via burial or cremation. Obviously, the executer of one’s will is important to ensure one’s wishes are met This executive of your will must be a very trusted person that you know will be around after your death.
Secondly, there are a variety of beneficiaries that are listed on the will. You can distribute individual possessions but primarily, homes, cars, financial legacy are left to primary beneficiaries. They can be listed in order as well, if one is no longer alive, proceeding down a chronological order.
The legal binding of a will depends merely upon a signing an official form and having a non family related witness and notary sign it. Some individuals prefer going to an attorney and that is fine as well. Ultimately, anyone, young or old, should have a Will in place. As one becomes married, has children or accumulates assets, this becomes even more imperative.
Not all disasters result in death and this is why it is also important that one’s wishes are met in the final two documents; A Living Will and Power of Attorney. These two documents are closely related. One deals with medical issues while alive if unconscious or unable to make decisions and the other deals with giving a particular person certain powers to carry out your life. A Living Will hence deals with a multitude of issues if you become extremely ill and unable to function. A Living Will dictates medical procedures according to one’s wishes.
Among the numerous things that can arise during a medical emergency in which you lose consciousness can be how your care is to be properly administered. How long do you wish to be left on a ventilator, or feeding tube? If a comma results and one is brain dead, how long do you wish extraordinary measures to be carried out? Do you wish to be resuscitated? What is your preferred pain management? Furthermore, do you wish to have organs donated if not listed on your license? These are extremely personal decisions and if no written documentation exists to guide physicians or family, then one’s medical care can be dictated from outside sources.
A Power of Attorney plays an important role in this. If a person is listed to fulfill your care needs while incapacitated then they can dictate the policies or if No Living Will is in place, carry out what you wanted from merely discussions although again this leads to the issue of trust. A Power of Attorney bound to the dictates of a Living Will are always best. The limit of the Power of Attorney is up to you. The person can have only power during the illness, or be given only a certain amount of time. Usually, the Power of Attorney also has other powers given to him or her. They are able to access all legal and financial matters, access accounts and pay bills in your absence. Again, the limitations are up to you in what your Power of Attorney can do and not do and for how long. Again, due to death of others, sometimes, these documents need to be updated, but to have a person in place you trust is essential in planning.
Yes, death can be a difficult discussion but it is an important one. This aversion to death and dying talk is not healthy. It is part of life and can open many conversations that are critical to relationships but most importantly it can open discussions about legal and medical ramifications that are critically important. Written and legally binding documents are essential to prevent disputes and one’s wishes not being honored.
Please also review AIHCP’s Pastoral Thanatology Program and see if it matches your academic and professional goals. The program is online and independent study and open to qualified professionals seeking a four year certification in Pastoral Thanatology
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.
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.
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.
When helping the dying, it is also critical to help them with their spiritual beliefs. This may well involve one dealing with another one of a different faith. It is important to try to find one a representative of one’s faith as soon as possible if death is approaching or if one needs spiritual rituals conducted, but if not, and it is not possible, it will be important to be able to sojourn with the dying.
It is important to respect the dying’s wishes, their religious beliefs and to listen. It is also helpful to have some knowledge of other faiths and the beliefs that coincide with dying. Please also review AIHCP’s Pastoral Thanatology Program and see if it matches your academic and professional goals. The program is online and independent study and open to qualified professionals seeking a four year certification in Pastoral Thanatology.