Death Is Inevitable

Dying with dignity

By YEO PUAY HUEI

Death is inevitable, and a person at death’s door requires the highest level of empathy (to be distinguished from sympathy). - AFP

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De-mystifying death: conversations with those facing end-of-life scenarios.

THANKS in part to a greater awareness of good hygiene, extensive health programmes, and advancements in the medical field, people are now living much longer lives.
For many, death is no longer regarded as a natural phenomenon. Instead, it is often seen as a failure of medicine and care – a brutal thief of time, and therefore, shunned and not discussed.
Yet, death is inevitable, and a person at death’s door requires the highest level of empathy (to be distinguished from sympathy).
This is vital to allow the person to “pass on” with dignity.
What does “preserving the dignity of a dying person” mean?
In a 2002 study of terminally-ill cancer patients, researchers concluded that dignity-conserving care depends not only on how patients are treated, but also how they are regarded (ie when patients know they are seen as being worthy of honour and respect by those who provide care to them). When this situation exists, dignity is more likely to be preserved.
It demonstrates that it is not just the physical care of a patient that is important during end-of-life scenarios, but also mental and emotional well-being.
For example, having efficient domestic help for an aged or sick parent at home is no substitute for family members offering kind words and loving gestures each day.
How does one talk to a dying person in a way that will help the person negotiate the process of dying with some measure of dignity?
Some examples offered by psychologists and mental health experts include:
For physical discomfort: Instead of “How are you today?”, ask “Is there anything I can do to make you more comfortable?”
For emotional distress: Instead of “How are you feeling?”, ask “How are you coping with what is happening to you?”
For anxiety about death: Instead of “Don’t worry, everything will be fine”, ask “Are there things in the later stages of your illness that you would like to discuss?”
For frustration at reduced independence: Ask “How much are you able to do for yourself?”
All these questions are more likely to elicit an informative response that will enable you to consider how to better comfort and support the person.
One of the great sufferings endured by the dying is a sense of helplessness and uselessness. Therefore, if the person is able to do simple tasks, we should facilitate that.
Or during your chats with the person, there are questions that may empower and uplift the dying person’s mind, such as:
“Are there things about you that this disease does not affect?”
This allows the patient to identify aspects of their life still within their control, and also gives you an idea what the patient values most in life.
“What about yourself are you most proud of?”
This enables the dying person to recollect positive qualities that they possess, or noble deeds done.
“What part of you feels strongest right now?”
This allows the patient to do things that enhance their sense of ability and well-being. Or it could open the door for the patient to tell you about their frustrations and fears.
Whatever the physical condition of the patient, as long as their mental faculties areintact, they can still use their mind to alleviate suffering. For example, the patient can calm the mind through mindful breathing, enjoying music, or reflecting on whatever faith system they follow in order to place the mind into a positive, virtuous state (but on no account is this the time to pressure a patient to alter their faith system, as that could induce emotional trauma).
An empowered mind is one with dignity.
Psychiatrist Dr Elizabeth Kubler-Ross’ pioneering work with the terminally ill shows that most patients welcome the opportunity to speak openly about their condition, which led to her formulating the famed five stages of death: denial, anger (“Why me?”), bargaining (for more time), depression, and finally, acceptance – though not necessarily in that order.
Gently and openly conversing with the terminally-ill patient about life in general, their life in particular, the end of life, worries, fears, joys and assurances that loved ones will be taken care of, are all ways of helping the dying person arrive at the stage of acceptance, as well as some level of contentment, and indeed, moving on with dignity.
For more information about end-of-life issues, e-mail manager@kasihfoundation.org.

Yeo Puay Huei is a member of Kasih Hospice Care Society. This article is contributed by The Star Health & Ageing Panel, which comprises a group of panellists who are not just opinion leaders in their respective fields of medical expertise, but have wide experience in medical health education for the public. The members of the panel include: Datuk Prof Dr Tan Hui Meng, consultant urologist; Dr Yap Piang Kian, consultant endocrinologist; Datuk Dr Azhari Rosman, consultant cardiologist; A/Prof Dr Philip Poi, consultant geriatrician; Dr Hew Fen Lee, consultant endocrinologist; Prof Dr Low Wah Yun, psychologist; Datuk Dr Nor Ashikin Mokhtar, consultant obstetrician and gynaecologist; Dr Lee Moon Keen, consultant neurologist; Dr Ting Hoon Chin, consultant dermatologist; Prof Khoo Ee Ming, primary care physician; Dr Ng Soo Chin, consultant haematologist. For more information, e-mail starhealth@thestar.com.my. The Star Health & Ageing Advisory Panel provides this information for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star Health & Ageing Advisory Panel disclaims any and all liability for injury or other damages that could result from use of the information obtained from this articl