What can we do to end our lives with dignity? This question is answered by the American writer Jordan Rosenfeld – she tells her story and accompanies it with the results of research and the opinion of experts.
“That was 9 years ago. My stepmother called me and said that I should visit my grandmother. Grandmother was 92, she was almost blind and deaf and could no longer enjoy her favorite books and music. She spent most of her time in a wheelchair, because she suffered minor strokes that caused her to fall constantly, and she never liked to lie in bed. Now she told the nurse that she was ready to die, and we all took these words seriously.
I managed to arrive and spend the whole day at her bedside with other members of our family. We said that we were letting her go, and at night she died quietly. I thought it was a good death. However, apart from this experience, I didn’t really think about what it was like to come to terms with death.
And just recently, the American Journal of Geriatric Psychiatry published the results of a new study based on 36 previous surveys of terminally ill patients, their families, and healthcare professionals caring for the dying.
Summarizing these results, the authors identified 11 main rules for a “good” death. Here they are:
- The ability to determine how we die.
- Absence of pain.
- Involvement in any religious or spiritual practice.
- Good emotional state.
- The feeling of completeness of life, the feeling that we will leave something behind.
- Possibility to choose treatment.
- The ability to maintain one’s dignity in the process of dying.
- Having a family and being able to say goodbye to her.
- Decent living conditions in the period of dying.
- Good relationship with medical staff.
- Miscellaneous: Some cultural specific requests, pets, medical costs.
Given these factors that we associate with the peaceful process of dying, we can better prepare for the death of those we love, and for our own.
Choose how to die
Most of us don’t like to talk about death. Still, talking about how we’re going to end our lives is necessary, says study lead author Emily Meyer, a psychologist and palliative care specialist at the University of San Diego. And it’s best to discuss all this ahead of time. Then later we will be able to better cope with all the accompanying emotions.
The best option, according to Emily Meyer, is to write down your wishes in this regard and discuss them with loved ones. This allows you to maintain a sense of control over your life in the face of inevitability and even to see meaning in the process of dying. “When my mother’s life came to an end, I was incredibly helped by a clear understanding of what she herself would like,” says writer Natasha Billauala, who lives in Los Angeles.
Both her parents left detailed written instructions long before their deaths, noting which procedures they wanted and which they didn’t, and which decisions they allowed their children to make on their behalf. Natasha Billauala talked about death many times with her mother, who suffered from a neurodegenerative disease (amyotrophic lateral sclerosis).
Did her mother’s death meet the criteria for a dignified death as outlined in the study? It turned out yes and no. Her mother was not yet ready to leave. But the loss of vital functions prevented her from making the final decision and hastened her demise. Nevertheless, the writer is sure that the opportunity to be close to her mother at the time of death is a gift. “There was so much love in it, I was so included in what was happening to her – it was wonderful, and it will always remain with me.”
Painlessness
Dying can take a long time. Sometimes patients are forced to ask to be given painkillers or turned off life support machines to end their suffering. Natasha Billauala’s mother spent her last days on morphine. My grandmother also took drugs for chronic pain.
It cannot be said that her death was easy. Before her death, her lungs were barely working, her arms and legs were trembling, she rolled her eyes … but I think you can say that she was as calm as possible at such a moment. In any case, it is easier than if she was urgently taken to the hospital and started to connect to all these devices.
Not surprisingly, many in the end refuse active medical intervention and simply want to leave in peace.
Emotional well-being
Well-being is the totality of all the reasons why we want to live, as defined by the writer and physician Atul Gawande. Among these reasons are simple pleasures: attending a concert, walking or reading a book. “When we become the victim of a serious illness or injury and our mind or body begins to deteriorate, what compromises are we willing or unwilling to make?” he asks.
This can be clarified for yourself if you write down your wishes in advance, based on the question “What quality of life is desirable for you?”. Psychologist Chris Kevorkian, who specializes in helping people experiencing grief, loss, and dying, encourages her wards to do this.
The hospital environment can be unsettling for a sick or dying person, so Chris Kevorkian advises relatives to try to create a familiar environment, for example, through music, favorite smells, or just talking. And in some cases, it is worth considering whether to return the dying home. Natasha Billauala says that for her mother, the most important thing before her death was that the children were with her. The presence of family members nearby gives peace to the departed.
Talk openly about death and dying
Those who speak openly about death while they are still in good health are more likely to face it with composure when their time comes. That’s why Emily Meyer supports the idea of ”death cafes”, which are gaining more and more popularity. They gather informal groups, the purpose of which is to learn to calmly talk about death in a cozy atmosphere, over a cup of tea with a cupcake. Here you can discuss everything related to this topic – from the likelihood of life after death to cremation and mourning rituals.
Doctors and nurses would also do well to overcome their reluctance to openly discuss death, said Dilip Jest, a geriatric psychiatrist and co-author of the San Diego study. “We doctors are always taught to think about how to prolong life,” he says. “Therefore, we begin to perceive every death as our personal failure.”
While most physicians are convinced that discussing the end of life would be important, a recent American poll found that almost half (46%) of physicians do not know how to talk to patients about death. Perhaps if doctors understand what a good death looks like, then they themselves, and ordinary people, will be better able to help patients make this natural transition to another world.