EP :Clinical Implications and Terminal Illness

How do we, as clinicians, help people to die? Some researchers indicate that clinicians can best help by facilitating the patient's acceptance of death. By acceptance I mean acceptance of the cessation of biological life, and not the desire to end pain (euthanasia and suicide being seperate issues). We can resign ourselves to death, but, to me, acceptance connotes an embraceable committment, of sorts to a process that goes against our human nature for survival.

Acceptance of death is contrary to our genetic encoding. We "Do not go gently into the night..." (Dylan Thomas), but fight tooth and nail for survival at all costs (genetically speaking).

From conception we move towards mutuality and cooperation, the goal being genetic survival. Mother and fetus share oxygen, blood, life itself. Throughout life we continue towards wholeism in our family systems, kinship, mating, etc.. In dying we are forced to tear ourselves away from that mutual wholeism that is deeply imbedded in our roots.

My own thoughts are that the dying process is a subjective grieving process, if we have the luxury of knowing that we are terminal ("luxury" being my own bias). We become aware that we are dying, we experience the losses of the death of parts of ourselves, our independence, loved ones to leave behind, bodily function, role changes, decision-making capabilities, possible cognition, towards a gradual resignation of the inevitable. To facilitate this grieving process is to facilitate the dying process.

But this is just the beginning of intervention. There's the all-important hope factor.

Hope, is the necessary bridge between biological life and the need to believe that life, in some form, will go on. The dying individual needs hope, not acceptance, to die well.

From a genetic perspective we need to know that biological life will continue. Our soulful, psychic side needs to believe we did not live in vain. Our emotional side desires to leave a part of who we are, behind, for those we have loved.

Songwriters claim that, in the end, love is all that matters. But we are a species of alliances. Alliances promote survival, and they include, but also transcend, mating, maternal bonding, kinship, etc.. Death tells us we have to tear ourselves away from a lifetime of alliances, and collective wholeness.

For the dying patient who identifies with organized religion the clinical implications for promoting hope are obvious. Where there are no ties to organized religion, we can suggest that the cycle of life, love and /or alliances; the collective "we", goes on. This cycle is the rebirth of nature, of which humans are an intricately beautiful part. Because we "are" and "were", so too "they" will continue. Thus the essence of everlasting life, or for others "genetic eternity".

T. S. Eliot wrote -- I am in "music heard so deeply/That it is not heard at all, but you are the music/While the music lasts...". I would add that the music that we are in life, is heard by others, and that the music goes on for them, after we die.

Mary Beth

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