Note: this piece is adapted from an article published in the December 2012/January 2013 NAELA News written by Tani Bahti, RN, CT, CHPN who is the founder and Executive Director of Passages – Support & Education in End of Life Issues, and the author of Dying to Know -Straight Talk About Death & Dying. For more information visit http://pathwayseol.com
“A good death does honor to a whole life.” -Petrarch
At the end of life, it is helpful to understand the natural process of dying. When facing a potentially terminal illness, having this information allows truly informed decisions.
The body naturally understands how to protect itself and to promote comfort. Just as the body goes through certain stages to prepare to be born, it also goes through certain stages to prepare to die. It is important to know what the natural and normal changes are, so as not to interfere with the natural process, and not to create more discomfort.
Without understanding the natural physical process of the body, decisions may be made from fear, lack of information, or misinformation. This can lead to devastating physical, emotional, and financial consequences for the patient and family who seek futile or even harmful treatment at the end of life. Knowing and honoring the natural process of the body, will help in making the best possible choices at the end of life. This piece discusses some of the most common myths surrounding the dying process.
1. Dying is painful.
Pain is not an expected part of the dying process. Many people experience no pain whatsoever. If a particular condition does cause pain, however, the pain can be managed by medications prescribed by a properly trained clinician.
2. If a person does not eat, the person will starve to death without a feeding tube.
The needs of the body and its ability to process and use food, changes in the final months of life. People do not die because they are not eating, but rather they do not eat because they are dying. Complications from forced feeding and the use of tube feedings, can actually hasten dying. One reason why a person is more comfortable when not eating, is that endorphins, the natural pain killers in the body, are released to promote a sense of well-being and comfort.
3. Not drinking leads to painful dehydration.
Natural dehydration is comfortable; it causes the release of endorphins which promote comfort. Unlike in a healthy person, providing artificial fluids near the end of life may actually increase discomfort. Natural dehydration results in less chance of nausea and vomiting, swelling, and lung congestion.
4. It is essentially killing the person if every possible technology is not used, or if machines to keep a person alive are stopped.
It is the disease that kills, nothing else. A dying person is only on machines because of illness. When dealing with a progressive or terminal illness, the use of machines may only prolong dying, rather than prolonging good quality of life. Just because technology exists, does not mean using the technology is always the best or most appropriate care.
5. If a person is allowed to stay in bed or sleep as much as desired, the person is abandoning hope so will die sooner.
Energy diminishes throughout an illness. To push beyond the natural limit will not strengthen the person and may further deplete what little energy remains, thereby increasing strain on the already fatigued body.
6. A person must be conscious until the moment of death. If a person is increasingly tired or confused, that means over-medication.
The dying process almost always causes the person to sleep more and more, until drifting into a coma. Sleepiness and possible confusion are often due to natural chemical and metabolic changes in the body as it begins to shut down, and they occur even when a person is not taking any medications at all. Proper management of medication can eliminate pain without contributing to confusion nor hastening the dying process.
7. Narcotic pain medications will cause loss of control or even hasten death.
Adequate pain medication can actually give more life, providing better rest and therefore more energy and comfort actually to accomplish desired tasks. Inadequate pain control can harm the body and even hasten dying due to damage from stress hormones, increased risk of clots, or complications of immobility because one has too much pain to get out of bed. Properly prescribed medications do not hasten death. They help to maintain comfort during the dying process.
8. It is too late to say goodbye when a person is in a coma.
A person can hear and can benefit from touch, until the final breath. When a person is in a coma, reminisce aloud, hold the person tenderly, tell the person what the person means to you, that you will be sad when the person has died, that you will also be alright, and say goodbye.
9. Dying ends in a final struggle.
In the end, most people essentially “die in their sleep” due to a coma that can last from minutes to days, depending on the disease.
10. Not being there when a person dies, means one has failed the person.
The timing of death itself can be remarkable. Sometimes a person will wait for someone to arrive; sometimes a person will wait for everyone to leave the room before dying. There is no good reason to judge who is or is not there at the moment of death.
Understanding and honoring the dying process, helps better decision making, preparation, and comfort, at the end of life.