| Death and Dying |
 Few subjects are more
stressful to discuss than death and dying. Cultural
background helps to determine one's attitudes toward
death. In a religious society, in which people view the
process of dying as a natural transition from one state
of being to another, the though of death often causes
less fear. Western culture, on the other hand, has long
viewed death as a forbidden subject. It has been
customary to cope with death be pretending that it wasn't
approaching, despite all evidence to the contrary. This
denial isolated the dying person from society, friends,
and even close family members. In recent years attitudes
have begun to change somewhat, and death and dying now
are discussed more candidly.Research teams studied the emotional responses and needs of the terminally ill. They found them usually willing and eager to know about and discuss their circumstances. Moreover, they noticed that most people sensed they were dying without being told. According to their research and to several more recent studies, openness enables the dying person, the family, and the medical community to share some of the emotional burdens of terminal illness and to show compassion for one another. Frankness also permits the terminally ill individual to deal with such issues as reconciliation, resolving conflicts, and pursuing treatment options that provide some amount of continuing hope. Furthermore, openness gives dying people more chances to determine their own destinies. They even may prove able to manage much of their own care in their final days. Some people decide to avoid aggressive medical treatment, particularly involving machines capable of artificially maintaining life, while continuing to accept everyday care. Some terminally ill people and their families choose hospice care for their final weeks or days. |
| The Right to Refuse Treatment |
| Saving lives is the goal of medical care. The dying
person who wishes to refuse life-sustaining measures
(such as mechanical ventilation or artificial feeding)
and to specify 'no code' or 'DNR' (hospital terminology
for no cardiopulmonary resuscitation if the heart stops
beating) must express the intent clearly to family
members and medical caregivers. The wishes must be made
known as early in the illness or hospitalization as
possible, or even beforehand, when the individual's
mental competence to make such decisions is
unquestionable. A living will (instructions to family and doctors about what should be done, or not done, in the event of a medical emergency), prepared in advance, may be of great help in guiding family members and physicians who may have to make critical decisions. |
| Grieving and Mourning |
| Every major loss elicits grief and necessitates
adjustments through a process of mourning. The sudden
disappearance of good health or the need to make dramatic
changes in customary routines will cause varying degrees
of grief for the person who is ill. For close relatives
and friends left behind after a death, mourning is a
complex and often long-term matter, frequently leading to
bouts of intense sadness and feelings of loneliness,
guilt, and abandonment. These emotions may persist in
some form even years later. Those who are facing imminent death also grieve the loss of their own life. Research has identified five emotional stages of grieving commonly experienced by the terminally ill. (See the box below). These stages may occur consecutively, or they may overlap or diminish before returning with greater intensity than before. Some people who enter the first stage refuse to believe that they are dying and therefore do not experience the remaining stages. For a terminally ill person, acceptance of death may be extraordinarily difficult to attain. Coming to terms with the life already lived--acknowledging, for instance, that some goals were accomplished, while others will never be achieved--enhances the possibility of accepting one's inevitable mortality and focusing on the life that still remains. Acceptance of impending death goes hand in hand with a loss of interest in, and withdrawal from, outside attachments, including close family ties. It is important for family members and dear friends not to confuse the normal process of separating from life with rejection. |
Stage One
