A Good Death
Sensitive and appropriate pastoral care that includes attention to spiritual needs, together with sensitive medical treatment, are elements of what is often described as “a good death.” Existing is not living, yet some medical caregivers still confuse an extended length of days—more existing time—with good living time.
I remember during my time as an intern chaplain to an intensive care unit working with a 90-year-old mother of two daughters who was a patient. Hilda was on life support and hooked up to a series of tubes and wires; she was very uncomfortable, with no quality of life at all. The daughters were understandably upset by the way their mother looked and felt, but the young physician thought there was a chance that with another round of treatment, Hilda’s life might be extended, so he went in to talk with her.
The young man carefully explained how the extensive and likely painful treatment would be carried out. He was detailed, he was considerate, and he was careful. Hilda had a breathing tube down her throat and so she couldn’t voice a reply to the doctor, but her gesture with her one good arm was very clear. She pointed upward with her fingers three times. It wasn’t more treatment she wanted; it was her release to go to her “heaven.” She was taken off life support, and in a few hours she had died. Her death was the compassionate way for her and a huge relief to her daughters.
The compassionate doctor will be ready to let her patient go and make her comfortable with appropriate drugs. As a pastoral caregiver you will want to encourage the physician in this course of action.
A good death is what is looked for when it is most likely that a person’s life is coming to an end. For the clergy person or worship leader in a pastoral care role, there will often be an opportunity to play a part in this process.
A key factor in the process of moving toward a good death is that wherever possible the dying person is in charge of her own dying. She calls the shots when it comes to treatment, especially the painkilling drugs that she takes—the amounts that are administered to her or that are available to her for self-administration.
It is the dying person who decides which visitors will come to see her and how long they will stay. It is the dying person who determines her priorities for the limited time she has left on this earth and, as far as is possible, where she will end her life. It is easy to spend a lot of time and energy bemoaning the fact that a human life is ending and so many things are no longer possible: holidays that cannot be taken, friends that cannot be visited, hobbies that cannot be pursued, and grandchildren who cannot be seen growing up. These are incalculable losses that a death deadline renders inevitable, but the effect of this deadline is to make other events possible that could not possibly happen if life without a limit continues.
During my ministry I have from time to time been one of those persons who hears the fifth step of Alcoholics Anonymous. This is the time when the addicted person writes down those hurts he has inflicted on others in great detail and having completed the list to the best of his ability, reads it aloud to one other person. Having completed this step, he does his best to make amends to every person he has harmed or slighted.
For the dying person, there is the possibility of asking forgiveness from those whom he has harmed and getting together with those with whom he has been in conflict. The new factor, the approach of the death deadline, makes it more likely that resolution will be achieved.
This is particularly true of major disagreements in the family circle, which can be bitter and prolonged. The upcoming death of a family member can be the incentive necessary to end the harsh words and to enable the participants to forgive and forget. The clergy person or pastoral caregiver can be the one who hears of the conflict and gets the process of reconciliation underway. He can be a good death initiator and catalyst. A useful question that he can put to the person who is dying is “Now that you know your life will end soon, what is it you need to do? Who is it you need to see?”
There is an often used phrase at this time: “You need to get your affairs in order,” and this is usually thought of in financial terms. Have you got an up-to-date will and do you know where it is? Have you got joint bank accounts with your spouse, and are you ready to talk to your bank representative about how his life will change financially? Are your life and other insurance documents in an accessible place? Does your partner know what investments you have and where they are held?
The death deadline is a major incentive to get your financial house in order, and sometimes the dying person needs to be reminded of this. However, there are less practical aspects that come at the end of life that come under the category of “Things I have always wanted to do, but never quite got round to.” It may be something as simple as having a soft ice cream with chocolate and lemon swirls or as major as going to Paris to see the Mona Lisa; as easy as calling up an old school friend to see what he did with his life or as momentous as taking a helicopter ride over the Grand Canyon.
One of the observations of dying people is the way taken-for-granted experiences take on fresh and vivid meaning: how the rolling clouds seem so wonderfully shaped and compelling as they move; how the smile of a grandchild is suddenly so full of meaning; and how the touch of a friend brings back a multitude of past experiences. As one of the caregivers for the person whose life is ending, you might ask the person dying a question that gives them the opportunity to express some of these deep feelings:
“I saw a smile come onto your face when you took a sip of water just now,” says the pastoral caregiver.
“You know, I have just realized how good a sip of cold water tastes on my tongue,” responds the dying one.
“You surely were paying close attention to those flowers the last visitor brought,” says the pastoral caregiver.
“It’s a long time since I looked at a rosebud and realized how delicate were the petals, how glorious the scent, how beautiful the delicate shade of pink,” responds the dying one.