‘A happy death’: the purpose of palliative care
Palliative care provides comfort for those who are in the process of dying. It seeks to provide care in every respect, physical, social, cultural and spiritual. Just as we seek quality of life at every moment, we also seek quality in dying. We seek not a death which is just doom and gloom, but a happy death.
The relationship between doctor and patient should be informative and sensitive, not adding to the difficulties experience by the patient and the family. The doctor is not a threat to the experience of dying.
Palliative carers have a sense of the innate dignity of every human being, whatever their achievements in life or their present condition. This innate dignity is a value which all religions share, whatever they have done or failed to do.
The palliative care nurses have performed a whole range of services, and exercise a coordinating role. They not only see that this will require more resources, day centres but will have flow on effect in the whole of society. The lack of de care for those who are dying will have a deleterious effect on those who are in good health. A pall of glom will spread over society.
A time comes for people to accept that they are dying. A time comes also for family and carers to acknowledge this fact. The excessive requirement for every increasing intensive care is driven by the fear of litigation. Protection must be given to palliative care nurse and doctors against the threat of unreasonable litigation.
A range of people are involved in the process, not only the professional palliative care professionals whose role is vital and central to the process. The attitude of those around them is crucial and will project itself onto their own self-understanding. The attitude of those around them is all important, to demonstrate an active compassion love for people at the end of life, a respect of them in their dying in this crucial moment.
In the Christian tradition, dying is a moment of particular value, not just the end of life but a transition.
“In the eyes of the unwise …. their going looked …. like annihilation, but …. grace and mercy await those God has chosen.” (The Book of Wisdom 3.2-3, 9.)
In our limited vision we may distinguish between the living and the dead, but Jesus teaches that
“To God all people are in fact alive.” (Luke 20.38)
Dying can be viewed positively or negatively. People in this situation are focused not just on their physical condition but also on their spiritual state. They teach us what is important. The modern attempt to escape from death, hiding the process in hospitals, has a deleterious effect on life as s whole. We can fall into illusion. Dying becomes the great obscenity, whereas it is part of human existence.
Dying is, in fact, a time of increasing freedom. There are no distractions from the goad of ambition or the limited focus of a work in hand. It is a time for people to come in touch with their whole life, to review life in its every aspect, to review their relationships, their acts, their choices, and to do this personally or with friends and relatives, perhaps with the assistance of a minister of religion. It is a time of review, acknowledging the achievements and relationships. It is important to have this opportunity to heal relationships, to bring life to a satisfactory close, a time of reconciliation and farewell, self forgiveness and seeking forgiveness also from God. It is a time to seek reconciliation where needed; to say the things they always wished to say but perhaps did not have the opportunity. It is a time to acknowledge the gifts that have been given, those moments of peak experience, of enlightenment which occurred at the depths their being, and which bear fruit in eternity. It is a time of hope, of consolation of promise. All this needs to be done in a situation of calm, and competence and love.
It is a question of making one’s will, not just in terms of disposition of property but in acknowledging what has been a valuable and offering it. Please accept it as my offering to you. Though they are physically and mentally weak, they are of infinite value. These questions could be asked: ‘What is the offering of your life? What place are you preparing for others in eternity? What will be your work from heaven? On whom will you shower gifts? For whom will you pray to God in eternity?
It is also a time of choice, the most valuable choices: what gift from your whole life do you wish to offer those who are closest to you and to humanity as a whole. ‘This has been my life for you.’ They set the foundation-stones of their eternity. We can’t determine our span of life, but we can fashion our eternity. Dying is not just an ending but a change of life-style. These are the seeds planted in time which will bear a harvest in eternity. The patient reflects on these and acknowledges and chooses and offers. They are not powerless, but supremely powerful for it is a time of making ultimate choices.
This is the true dignity.
These things are done while the person has the mental and physical capacity to do so. But they may need help since not everyone is capable of such reflection. To sit with them and hear them. To provide biography services
It is a time to allow others to take care of them, to show their love and to make some return for the good that they have received, not to render them powerless or useless. It is a time to accept no longer to be independent, but to surrender into the care of others. It is a time for trust.
It is a time of profound experience, comparable to the experience of the mystics who enter into the ‘dark night of the senses’ when the pleasures of the past mean nothing any more; but also the ‘dark night of the soul’ where understanding fails but faith does not; where memory fades but hope spring eternal; where desire ceases, but love becomes real. They are coming to the deepest level of their being: “There are three things that last: faith, hope and love, and the greatest of these is love.” (I Corinthians 13.13)
It is a time also to prepare one’s own funeral, to use it as an opportunity to make a statement about one’s life and one’s eternity. Selecting the readings.
It is a time of great discernment, knowing when to fight against all odds, and when to allow nature to takes its course. There is no obligation to continue with treatment that has become burdensome, in fat worsening the situation worsening the process of dying rather than solving it. There can be fear of litigation.
In the past the question facing humanity was ‘how to survive?’ The issue facing us here is ‘how best to die?’ Our answer to these questions will determine the character of our laws and their application. What sort of world do we want? The great religions of the world have thought long and hard about these matters.
The word ‘life’ encompasses a wide range of meanings. Indeed, it exceeds definition. A person can be alive physically, but emotionally moribund, and socially dead, a member of the walking wounded. A person can be intellectually brilliant but with an uninformed conscience, a moral zombie. All dimensions, physical, emotional, intellectual and moral, are necessary in a well balanced life. But another dimension is foundational to our discussion here. It is the domain of the spirit, which is not reduced to the other faculties. The vitality of the spirit is expressed in the love of friend and foe alike, in returning good for evil, a blessing for a curse. This love is not unreasonable; it is more than just reasonable; it is splendidly ‘foolish’. This spiritual vitality is expressed in universal forgiveness also, a pity which may seem mere folly but is the highest wisdom.
In this love and forgiveness there is an experience of Divine Presence which is axiomatic; it is a grace. That experience, like any other experience, can only be witnessed to; it cannot be proven; it can hardly even be described. Words fail.
The more we enter into earthly joy, the more we perceive the promise of endless joy. The more we live in the present the more we perceive we live in an eternal now. Emmanuel Lévinas, the 20th century Lithuanian philosopher, the student of Husserl and Heidegger, asks the question: is the human being oriented towards “infinity” – endless openness – or towards totality – “metaphysical closure”? Religions reject every form of totalitarianism and propose that endless openness.
In the religious traditions, there is a perception that the very foundation and substance of the universe is love and mercy. The question therefore arises, with what eye we see? Do we have the ears to hear?
These considerations have immense implications for the value of our human acts. Some may win fame and fortune but for most of us, our acts are pretty insignificant. Their value comes from the spiritual dimension which places them on a transcendent and eternal plane, in the context of an ‘endless openness’. They thus acquire infinite value and become the seedbed of eternity.
Is death an end or a transition, a disaster or an opportunity? Is death an unmitigated evil or does it have immense value. We need to cherish our dying as we cherish our living, for the knowledge of our mortality makes leads us to question the conduct of our life. What is really important? We are lead closer to wisdom by the question.
Furthermore, our mortality leads to our reviewing the tenour of our life, reaffirming what is good in it and turning away from the wasted opportunities. This is the great value of the aging process. Our life is transformed into a gift to others. Each person can then say: Such is my life. It is my gift to you, just as the life you have reaffirmed is a gift to me. Even the manner of our dying is our gift to each other. These are not passing gifts, for I am of eternal value to you, as you are to me. Let us live in communion.
This process of attaining wisdom and transforming our life into a gift is of such significance that we could wish that the young, who think they are immortal, should reflect on their mortality. Governments should assist in this process of aging and acquiring wisdom.
The question arises about the value of suffering. Our fear of suffering is right and necessary. Yet our world essentially involves the paradox of pleasure and pain. It seems to form the very fabric our universe. After all, the whole process of evolution, in which I firmly believe, involves the process of natural selection which in turn is based on the survival of the fittest and therefore on struggle and competition, the interplay of pleasure and pain, life and death. What is true for the evolution of the species is also true for human invention. As they say ‘necessity is the mother of invention’. When faced with the issues of life and death, we find new solutions which we would most probably not have sought till we ‘had our back to the wall’. Even in sport, they say ‘no pain no gain’. This general principle is found also in the religious domain as when, in Christianity for example, we speak of redemptive sacrifice. I shall return to this. Indeed, love is shown in sacrifice. Thus pain has a surprisingly paradoxical purpose, a lesson we naturally shy away from.
Is it possible to die with dignity? Dignity means more than ‘looking good’ or not being a burden or dying without pain, important though these are. It also means knowing the significance of our living and dying. It means being surrounded by those who recognise the value of our dying, who love us in our weakness and who have a sense of our eternal future, recognising that our passing is a momentous occasion, not just the end of things, like the end of a summer’s day. Henri Stendhal the 19th century French novelist said famously that “Beauty is the promise of happiness.” Despite the disfigurement that may accompany the dying process, the person who dies in the promise of happiness has a remarkable beauty about them. It is indeed a strange beauty.
Palliative care, seen in this light, takes on immense significance and will be an outstanding aspect of modern life and play an increasingly important part in our human future.
If despair predominates every joy has a ‘worm in the apple’. This in turn leads to a stoical ‘grin and bear it’ or to the frantic reaction: ‘Let’s eat, drink and be merry, for tomorrow we die.’ By contrast, the attitude of hope means that every joy is a foretaste, an anticipation of joy upon joy.
Here are a few lines from the diary of Etty Hillesum, a young Jewish woman who died at Auschwitz:
“Since I no longer wish to possess anything and have become free,
everything belongs to me, and my interior wealth is now immense …”