More About Death and Dying

For the past 20 years I have had a ministry with patients in nursing homes and hospitals.  That experience has taught me a lot about death and dying.  It is my hope that  this series of blogs has been and will be helpful for everyone who reads them.  Several items need consideration.

Having affairs in order

Not everyone has the luxury of planning for death. However, most of us want to retain some control and say-so in our final months and days of life. Those who take the time to think about and plan some of the details of their final care and comfort at death  are better able to retain some control over what happens to them.

Legal specifics of such planning include taking steps to get affairs in order by asking some basic questions:

  • Who will get my property and how should it be divided?  This can be achieved by having an estate plan with a will, trust, or other documents that set out how this should be done.
  • What kind of final medical care do I want?  Do I want life prolonged by artificial means?  What does a “do not resuscitate” order mean?
  • Do I want to be buried or cremated? Where will my remains be kept?
  • Do I want a funeral or memorial service? Who do I want to participate in my service? What music and readings do I want included?

Controlling pain and discomfort

According to recent polls, most of us say we prefer to die at home. The reality is that some three-quarters of the population die in some sort of medical institution, many of them after spending time in an intensive care unit.

A growing number of aging patients are not choosing life-prolonging treatments that might ultimately increase pain and suffering (such as invasive surgery or dialysis); deciding instead to have comfort or palliative care through hospice in their final days.

Emotional care and support

It is equally important to prepare for death emotionally, too. Several questions arise:

  • What quality of life do I want in my final days? Do I want to be kept alive as long as possible by any means possible though I may have no apparent cognitive functions
  • Are there relationships with friends and/or family that need mending before I die?

Often quoted in the literature on death and dying are the tenets of Ira Byock, MD.              Byock says a dying person needs to express four thoughts at the end of life: “I love              you.”  “Thank you.”  “I forgive you.” “Forgive me.”

  • Will I be treated as a live human being until the moment I die?

Though dying may be scary or sad or simply unfamiliar to those who are                               witnessing it, studies of terminally ill patients underscore a common desire to be               treated as live human beings until the moment they die.

Most patients also say they don’t want to be alone during their final days and                       moments. This means that caregivers should find out what kind of medical                           care the dying person wants administered or withheld and be sure that the                           medical personnel on duty are fitting in skill and temperament.

Favorite activities or objects can be as important as final medical care. Caregivers should discover what tangible and intangible things would be most comforting to the patient in the final days, such as favorite music or readings, particularly readings from sacred writings such as the Bible.

A spiritual dimension can help many people find strength and meaning during their final moments. What is the patient’s spiritual or religious understanding? What does the person’s spiritual understanding say about what happens after death and is their understanding adequate to sustain the person through death?

For additional help

  • Ira Bycock, The Four Things That Matter Most: A Book About Living, ed. New York: Atria Books, 2004, 2014.
  • Caring.com (https://www.caring.com/end-of-life) is an excellent online resource for caregivers seeking information and support as they care for aging patients and loved ones.  Caring.com offers thousands of original articles, helpful tools, advice from more than 50 leading experts, a community of caregivers, and a comprehensive directory of caregiving services.
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Spirituality at the of Life

Caring for a dying loved one isn’t easy. Even when you know the end of life is near, you might feel unprepared emotionally, physically, and spiritually. Understanding and knowing what to expect — and what you can do to increase your loved one’s comfort — can help both you and the one you love.

As your loved one approaches the end of life, he or she might talk about spirituality or the meaning of life, so encourage them to explore and address his or her feelings. If they do not have a saving knowledge of Jesus, share how Christ can come into their lives and give them eternal life. If the person has made a commitment to Jesus in previous years, is he or she secure in that Christian commitment or are there feelings of doubt? Are there unconfessed sins that need forgiveness? Are there broken relationships that need mending?

Communion might be helpful for friends and family to gather around the bedside and share the elements together with the loved one. This could be the occasion that could help your loved one say goodbye to friends and family. This also gives others an opportunity to say goodbye to the one who is dying. This would also be the time to have a prayer to commit the person to the Lord; giving thanks for sharing his or her life, asking for ease of pain and that God would draw the person to Himself and give her or him His love, His peace, and His presence.

Scripture passages can be read that tell of the faithfulness of God and His love and care. Other passages can point to the eternal assurance a person has through faith. Encourage your loved one to memorize some verses that give him or her added assurance of God’s love and grace eternal life.

Decide whether there will be a funeral or memorial service. Will there be a cremation or casket? What music is to be played and sung, and who are the musicians? What are the Scriptures to be read? There may be other details that would be helpful to the family and the officiating clergy in conducting a funeral service.

Your loved one might also find it comforting to leave a legacy — such as creating a recording about his or her life or writing letters to loved ones, especially to grandchildren.

Where Will You Die?

This is the second article dealing with death and dying.  The material has been freely adapted   available through the Mayo Clinics.

We can choose when we die.  We can choose, within reason, how we die. We can choose where we will die.  But, we cannot choose not to die.  Death comes to all.

Caring for a dying person isn’t easy. Even when you know the end of life is approaching, you might not feel prepared. Understanding what to expect — and what you can do to increase the person’s comfort — can help.

Most people will have choices for end-of-life care. Options might include:

Home care. Most people prefer to die at home or in the home of a family member. You can assume the role of caregiver or hire home care services for support. Hospice care — services that help ensure the highest quality of life for whatever time remains — can be provided at home as well.  The purpose of hospice is to ensure people die free of pain and with dignity. In many instances, you will not pay for hospice service.

Hospice provides an on-call nurse, medications, and medical equipment.  In many states hospice care is supported financially by Medicaid, and in other areas hospice care is supported by a hospital or by public gifts.

Inpatient care. Some people might prefer round-the-clock care at a nursing home, hospital or dedicated inpatient hospice facility. Hospice and palliative care — a holistic treatment approach intended to ease symptoms, relieve pain, and address spiritual and psychological concerns — can be provided in any of these environments.

Understand clearly what your family member wants at the end of life.  Talk with her or his health care team or a social worker. You might ask for a referral to palliative or hospice care specialists — health care providers trained in specific care for people nearing the end of life.

Also, understand what your hospital means by “Do not resuscitate”  and other terms. If your family member or friend has this phrase in their health directive, ensure everyone involved knows what  is meant and how that  fits into the person’s health care directive. If your loved one opts for life support, have an understanding of when you could”pull the plug”and end all treatment.

Whether you bring a dying loved one home or keep vigil at the hospital, you can take measures to provide comfort and relief at the end of life.

 

When Death is Near

This is some material adapted from the Mayo Clinic that I have used with families as they await the death of a friend or family member.  I hope you find this, and others coming, to be of help.

Caring for a dying loved one isn’t easy. Even when you know the end of life is near, you might feel unprepared emotionally, physically, and spiritually.  Understanding and knowing what to expect — and what you can do to increase your loved one’s comfort — can help both you and the one you love. A pastor or others in pastoral ministry can be of help to you.

It’s difficult to predict exactly when someone will die. As death approaches, however, your loved one might show signs indicating that the end of life is near. Look for:

  • A loss of interest in friends or favorite activities.  There may be glazed eyes with no sign of recognition. Do not take this personally, for there is no awareness of your presence.
  • Drowsiness, sleeping more, or having intermittent sleep.
  • Restlessness and agitation.While sleeping, the person might frequently change positions or pull at the bed covers or pajamas. Sometimes this can be a sign of pain.
  • Loss of appetite.Your loved one might eat and drink less than usual.  Trying to force them to eat or drink can cause food and water to be sucked into the lungs and  pneumonia or other breathing problems could develop. It is normal to want to feed them, for we feel guilty, thinking we are not caring for them properly.
  • Pauses or other changes in breathing.This could happen when she is asleep or awake.
  • Reports of seeing someone who has already died.Sometimes he may also tell you that he has seen Jesus, or heard music, or has seen a friend or family member who has died.
  • She might also experience a brief, final surge of energy. Though it can be confusing to see her with renewed vitality, remember that this is often a normal part of dying. If it happens, take advantage of the opportunity to enjoy her and say your final goodbyes.

For many families, keeping vigil near a dying loved one’s bed is a way to show support and love. If you decide to keep vigil, continue talking to your loved one, for hearing is one of the last things dying people lose.  They can hear when there is no evidence of connection with the external world, so take care what you talk about at the bedside.

If you think he or she would want to share this time with others, invite family members or close friends to show their support as well. Express your love, but also let your loved one know that it’s OK to let go and be with Jesus.