Sharing experiences of death and end-of-life care

From the past three decades of working in health care, in general and palliative care in particular, the author has recognised that the discussion around death and dying often provokes uncomfortable professional conversations. The author's experience indicates that such conversations are not only delicate or sensitive, but can elicit death anxiety in some people and overt avoidance of the topic in others. Death comes to every person at some point. Therefore, avoidance is not a rational option. For health professionals working with dying patients, every death might be a painful reminder of how fragile their own life is, and that they are thus forced to face their impending mortality.

The anxiety that this might induce in a person is a prolonged disabling state of worry, not necessarily because of death itself but what death means and its impact. The state of anxiety, if left unmanaged, can be demoralising and paralysing and, with no real progress made to resolving it, can also be disabling. Different cultures react to death in different ways: some welcome death as bringing an end to life on earth and any suffering associated with it, while others may view death as interrupting life and preventing the accomplishment of important goals (careers, family, etc.). As health professionals with our own culture, the challenge may be that we struggle to place our own cultural beliefs in check while we tend to the beliefs of the patients we care for. In other words, we struggle to see how our cultural values fit with the self (us), others and the world at large. The point is that, first, we need to be aware and comfortable with our own perspectives and beliefs about death and dying in order to be effective in supporting patients who are dying. For example, if we accept death as part of life, we may be better prepared to fully focus on living life and its joys and do those things that are important to us while we can. The opposite can only hold us back and result in frustration when death threatens to cut life short. The Dalai Lama (2002: 39) emphasised this point, saying ‘It is crucial to be mindful of death, to contemplate that you will not remain long in this life. If you are not aware of death, you will fail to take advantage of this special human life that you have already attained.'