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.