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End of Life Issues

Death and Dying: Are You Prepared?

GetWellness Online Health Interview
Edited version, English version, Ava (UK)

"In our Western culture we are so focused on creating things and keeping our lives busy that we really don't give ourselves time to contemplate death and other deep issues," says Pam Kircher, MD.

Dr. Pam Kircher is a board-certified family physician and a board-certified hospice and palliative care physician. She serves as the Medical Director of the Wellness Center at Mercy Medical Center. She has her counselling practice in Durango, Colorado, USA and is the secretary of the board of the International Association of Near-Death Studies. In 1995, Dr. Kircher published Love is the Link: A Hospice Physician Shares Her Experience of Near-Death and Dying. Since that time, she has spoken locally and nationally about near-death experiences and end-of-life issues.

GetWellness Online Health: Whether we accept it or not, one day we will all die. Why is there no preparation for death in our culture?

Dr. Kircher: In the Western culture, we really emphasize doing or making things. This is in great contrast to the Eastern cultures where people contemplate death as a way of seeing how to live. In our Western culture we are so focused on creating things and keeping our lives busy that we really don't give ourselves time to contemplate death and other deep issues.

GWOH: Many people think that you are negative or even morbid to talk about death, although the Swiss physician, Elizabeth Kübler-Ross has made many in the West more aware of that subject. Yet why do most people always seem to avoid any talk about death and dying?

Dr. Kircher: I think it's primarily because of a fear of death, and this fear becomes more intense when we don't talk to one another about it. I think there has been great progress since Dr. Kübler-Ross first began her work with dying people in Chicago in the 1960's. At that time the tradition among doctors was that it was a bad idea to tell people they were terminally ill. Medical students were taught that if they talked to their patients about the possibility that they might die in the near future, they would hasten their deaths. When Kübler-Ross first began talking to dying patients, many doctors thought she was unkind. It's amazing that she was even able to stay in practice. Nowadays, many US medical schools have courses on death and dying, and spirituality. While that is a great improvement over medical education in the 1960s, I feel that we still have a long way to go in educating the medical community about being with people who are dying.

GWOH: You mentioned fear earlier. How do we deal with it?

Dr. Kircher: I think a lot of this fear is a result of a strong emphasis on our bodies to the exclusion of our minds and spirits. In Western culture, many of us have come to see ourselves as bodies only. Consequently, we feel that when our bodies are gone, we are gone. In contrast to this viewpoint, religious philosophy strongly emphasizes Spirit. People who focus on the spiritual aspects of themselves often approach death in a more peaceful manner than people who have only focused on their bodies. Eastern culture generally concentrates on the spiritual aspects of life and people in that culture are not so fearful of death as we tend to be in the Western culture.

GWOH: Please explain to us what death implies, how does it differ from dying?

Dr. Kircher: I think of dying as a process of approaching death. A lot of people are afraid of the dying process itself because they are afraid of the pain that might be involved. I believe the hospice movement has been a great step forward in helping to control symptoms that are intolerable like pain or persistent nausea. Today hospice care is providing much better symptom management than dying people have received in the acute care setting in the past. The other difficult part of the dying process is the necessity of learning to let go. It begins when people can no longer do the work by which they may have defined themselves. It is difficult to say goodbye to activities that one used to do, to the people in your life and to everything you have known. As someone who has experienced near-death, I have no fear of death itself. I feel secure that when I die that's not the end of everything about me. I feel that my spirit will live on. A common theme among people who have had a near-death experience is an absence of fear about death. However, there is still sadness about having to say goodbye to every person and every thing we have known on earth.

GWOH: Many like to hide the fact from the ill person that he or she is actually dying. What's the right approach?

Dr. Kircher: I have found that when the family and the dying person can be totally open and honest with each other, the last few weeks of life can be the most powerful time in life. This is when one can make sense of relationships, say the things that need to be said, and forgive one another for things that have happened. Almost invariably, the person who is dying knows it. I invite people to think about how lonely it must feel not to be able to talk about your own dying if that is the one thing on your mind. Please do honor and respect your loved ones by allowing them to be open and honest about what is on their minds when they are dying.

GWOH: But on the other hand, we have the medical community that seems to treat death or dying as a failure.

Dr. Kircher: I think that's something doctors pick up in medical schools, though it's never actually said. There is this thought that we have so much technology that if we just know enough we can do more procedures to save the dying person. The truth is that every patient will die at some point, but there is this sense that 'Well, not while I am in charge, they won't die.' Doctors tend to think they can make you live another week by doing another procedure. The patients may be able to live another week or month, but how miserable will they be? Is that something the patient really wants to do? Or maybe the patient would rather not have another procedure, but prefers symptom management only, so that he or she can be comfortable enough to focus on what they would like to say and do before they die? So we need to be honest about what we are offering.

GWOH: What kind of environment would you consider to be the most conducive for someone who is dying?

Dr. Kircher: The most conducive environment is home. If people can get plenty of support from a hospice, they are most comfortable in their own home where their family can come and go. Family members are often afraid of caring for a loved one at home because they have no experience in providing nursing care. But if they have the help of a hospice that comes in with nurses, volunteers and social support, life is made easier for all. Most people I have talked with who have cared for loved ones at home have found it to be one of the most powerful and truly wonderful experiences of their lives.

GWOH: Many elderly people live in nursing homes. Which care facilities most closely approximate a proper home environment?

Dr. Kircher: I think the best thing is the in-patient unit of a hospice. These in-patient units may be a wing of a hospital or a free standing unit. Also, nursing homes often have a special section for hospice care. In those settings dying people can have hospice care that includes music therapy and volunteer visits. The goal is to make these environments as home-like as possible.

GWOH: What sort of changes would you like to see in the way death is dealt with in our culture?

Dr. Kircher: I would like to see more of an awareness of the ephemeral nature of how long we are going to be in our bodies. I would like to see people being more conscious of how they are living their lives so that when they are near the end of their lives they can look back and say, 'This was the life I wanted to live.' When I have been with dying people they didn't dwell on what they had accomplished, but they spoke of how they had related to their loved ones and how they had connected with their children. They spoke of the uselessness of long-held grudges. They contemplated whether or not they had honored their own deep inner needs. They spoke of the need to respect mind, body and spirit in daily life. I would like us to learn from these people who were kind enough to tell us what they were thinking at the time of death. If we know that those are the issues that we will be contemplating as we approach death, then I would like us to develop a culture that supports those values.

GWOH: How will a better understanding of death and dying affect the way we live our life or the quality of life we will live?

Dr. Kircher: The more we are aware of the spirit world the less we grasp onto material possessions. Life is much larger than our awareness of the purely physical aspects. Keeping this in mind on a daily basis has a profound impact on how we live our lives. If each of us lives a life that is fully aware of mind and spirit, death will not be so feared. If we live a life of peace, relationships will be positive, and forgiveness will not be such an issue as we approach death. And, most importantly, if we live a life based on the values that we have learned from people who are approaching death, I believe that each day of our lives will be fuller and richer and happier than we have ever dreamed of!


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