On Death and Dying
On average, for every 1,000 persons alive today, 8 will die in the next year; worldwide, an average of 1.76 persons die per second. In North America, catastrophic illness accounts for only about 20% of all fatalities; the majority of people will die naturally, due to long-term disease or the aging process. This gives most of us an opportunity to prepare for our own death and for the deaths of those we love.
At the same time, physicians have more people in their waiting rooms with more emotional problems than ever before. There are more elderly patients who live alone with decreased physical abilities and limitation, facing loneliness and isolation. In modern society, death is seen as a fearful, frightening happening; we put our elderly in homes for the aged and shield ourselves and our children from our ultimate demise. There is no real understanding of death, of what happens in or after death. Generally, people today are taught to deny death, living in terror and confusion.
Modern medicine has made incredible technical advances in order to prolong life; administering drugs to numb pain, suffering or other discomfort. And yet, for the most part people are not dying well. By concentrating exclusively on the physical aspects of care giving, western medicine has neglected to address their patient’s spiritual and emotional dying needs. Many of these issues have prompted us to search for better ways to understand and cope with the problems of death and dying.
The hospice movement has changed the face of end-of-life medicine and offers an integrative approach to the end of life, complementing and taking over for medical treatment when everything medically possible has been done for a patient. Hospices dotted Europe’s high Alpine landscape, which followed ancient Roman trade routes; some of the oldest hospices trace their lineage back to the year 1000 AD. The modern hospice movement came to America about forty years ago, due to the extraordinary work of English physician, Dame Saunders. A pioneer, Dame Saunders established St. Christopher’s Hospice in London and challenged the perception that people had to die in agony.
As a result of her vision, the modern hospice movement was created. A realistic hope appeared of a future in which nobody had to die alone or with pain untreated. A viable alternative was created, one which provided physical care, primarily palliative, at the end of life, while tending to the emotional and spiritual concerns of the dying person.
Another pioneer who was integral in changing the way we see death, as well as improving how we die, was Elisabeth Kubler-Ross, MD. By working with dying patients directly, Dr. Kubler-Ross was able to learn more about the final stages of life; treating patients as human beings and seeking their experience to better understand the strengths and weaknesses of our medical system. Her work helped us to realize how imminent death affects the patient, the professionals who serve that patient, and the patient’s family, bringing hope to all who are involved.
Through her work, Dr. Kubler-Ross recognized that patients at the end of life are acutely aware of the seriousness of their illness whether they have been told or not. This allowed us to understand the importance of communicating with and including the dying person in their prognosis, even when terminal. Patient’s reaction to the news that their condition was terminal was almost identical. The coping mechanisms that were experienced came in five stages: Denial, Anger, Bargaining, Depression and finally, Acceptance. When patients reached the final stage of acceptance, interference from outside was regarded as the greatest turmoil and prevented patients from dying in peace and dignity. No matter the stage of illness or coping mechanisms used, all the patients maintained some form of hope until the last moment. This hope should always be maintained whether we can agree with the form or not. It allows the patient to maintain their spirit and gives them the endurance they need through the end of their life cycle.
Kubler-Ross ultimately determined “though every man will attempt in his own way to postpone questions and issues related to death, until he is forced to face them, he will only be able to change things if he can start to conceive of his own death—This must be achieved by every human being alone. If each of us would make a start by contemplating the possibility of our own personal death, we may affect many things, most important of all the welfare of our patients, our families, and finally perhaps our nations.”
There have been many other significant contributors to the field such as Peter Levine, and a non-comprehensive listing of references is given in the resource section.