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Modules:

  • Introduction
  • 1. Advance Care Planning
  • 2. Communicating Bad News
  • 3. Whole Patient Assessment
  • 4. Pain Management
  • 5. Assisted Suicide Debate
  • 6. Anxiety, Delirium
  • 7. Goals of Care
  • 8. Sudden Illness
  • 9. Medical Futility
  • 10. Common Symptoms
  • 11. Withholding Treatment
  • 12. Last Hours of Living
  • 13. Cultural Issues
  • 14. Religion, Spirituality
  • 15. Legal Issues
  • 16. Social and Psychological
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    Back to Module 14: Table of Contents
    Part II: Common Needs and Goals

    Click here for a Special Note
    Finding Hope
    The Search for Meaning
    Sustaining Personhood and Community
    Coping with Change and Uncertainty
    Taking Care of Unfinished Business/The Need for Forgiveness
    Fear of Death, Questions About Life After Death & Spiritual Care at the Time of Death

    Fear of Death, Questions About Life After Death & Spiritual Care at the Time of Death

    Fear of Death

    • Fears about death itself and the dying process are common at the end of life
      • It is important to assess whether the person’s fear is about death itself or about the dying process

      • Common fears about the dying process include:
        • Fear of being in pain
        • Fear of suffocating
        • Fear of losing control of bodily functions
        • Fear of loss of mental functioning

      • Fear of death itself — of the cessation of life or transition to the next life, depending on the spiritual and cultural framework of the patient — may also have various causes
        • The unknown aspects of this event
        • Separation from loved ones
        • What awaits them in their next life

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    The Interdisciplinary Team Together Can Lessen These Fears with Education and Practical Assistance

    Questions about life after death - Avoid imposing your own beliefs

    • As members of the palliative care team respond to fears about death, there is a great risk of imposing our own beliefs
    • Patients and families are likely to ask such questions as
      • “What do you believe about the after-life?”
      • “Do you really think I’ll see my uncle John (deceased) when I get to heaven?”
    • Remember
      • Dying person and family are not often asking what YOU believe
      • They may be trying to clarify their own beliefs and find reassurance and hope
    • Be aware of commonly imposed beliefs…
      • If patients call upon the name of deceased loved ones or report “seeing” these persons in the room, many palliative care professionals unwittingly impose a spiritual framework upon this experience by suggesting that the spirits of the deceased are coming to the dying person to help them with the transition

      • Likewise, when a person’s dying is prolonged, we may look for “spiritual” explanations — “God isn’t ready for her yet” or “she must have some unfinished business here on earth” — that may or may not be in keeping with the spiritual framework and beliefs of the patient and family

      • A good death requires that a person be at peace

      • A good death requires that a person and their family accept what is happening, i.e., not be in denial

      • No one should die in pain

      • Reconciliation within a family is a shared value/goal of all patients

      • Family members should say goodbye and/or give the dying person permission to go

      • Death occurs at the moment breathing (or heart beat) stops
    • Use strategies that help patient and family explore and clarify their own beliefs
      • Putting the question back to them is a useful strategy:

        • “What have you been taught through your own tradition about the after-life?”

        • “Do you have any images or ideas about what it might be like?”

        • “What would you like for the after life to look like?”

        • “It sounds important to you that you connect up with family again in heaven. Would it be comforting to see your Uncle John again?”

      • Helping the patient and family to explore their own beliefs and clarifying what it is they are asking/in need of spiritually and emotionally at the time of death and in regards to life after death should be the role of all team members

      • Offering a list of possible explanations or a number of opposing beliefs provides some direction when persons are feeling confused about what they believe or want to do

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    Spiritual Care at the Time of Death

    • Defining death
      • Different religious and cultural traditions offer various definitions for “death” and “dead”

    Examples

    • Important factors at the time of death. There are several factors at the time of death that are believed to impact spiritual life after death, depending on the religious and cultural framework
      • How a person dies
        • For some religions and cultures, how a person dies — violently, peacefully, by their own hand or at the hands of another — directly relates to the quality and kind of existence the person has in the after life or the next life

      • Emotional and spiritual state as death approaches
        • The state of the dying person’s emotional and spiritual well-being as death approaches (peaceful/agitated, doubtful/trusting, alert/sedated, attached/released) is believed by some to impact their transition and life after this one

      • Care provided to the dying person
        • The spiritual and medical care provided by others to the dying person and what persons do for the soul and body of the deceased is also held to affect the spiritual life after (chanting, prayers for the soul in purgatory, how the remains are handled, ritual cleansing of the body, the emotional state of the bereaved)

      • Customs and rituals after death
        • Funeral and burial customs as well as mourning rituals that may last for months to years not only are believed to impact the spiritual existence of the deceased but serve the needs of the bereaved as well
    • Bonds Between the Dead and the Living
      • Beliefs about bonds between the dead and the living vary across cultures

        • Just as there are differences in how death and life after death are conceptualized by the various religions and cultures so there are vast differences in how persons understand the bonds between the deceased and the living

        • How these relationships are understood directly affects the process of grieving and the provision of bereavement care

        • These beliefs can have important implications for grief and bereavement

    Examples

    • Understanding and respecting these beliefs is essential for good palliative care
      • Asking persons how they think about these relationships is key to providing appropriate and helpful spiritual care
      • It is essential to learn about these spiritual frameworks both to bring comfort and meaning and to avoid violating (potentially soul-threatening) prohibitions
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