Deborah Golden Alecson | Musings on Mortality: Good dying time results in good death

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The very first module for my medical humanities course is called "Good Death: Oxymoron or Possibility?" A good death implies a good dying time leading up to death. The question is, can dying ever be good or is this unacceptable given it is, after all, dying — the end of life? Many of my students conclude after reading and viewing the required material that a good dying time and death is individual, but certainly requires dignity, pain management and a faithfulness to treatment wishes found in advanced directives. They come to understand that how we die is in direct relationship to how we have lived. A death-phobic and death-denying existence more often than not does not lead to a good death and that being tethered to machines in an ICU receiving futile care that prolongs the dying process can be the result.

There are also the emotional and spiritual needs of the dying that require attention. I knew a woman who went into hospice care at home, where she was cared for by her husband and daughter. Even though she was in hospice, her family did not talk to her as if she were dying. They did not want the rare few who were allowed to visit to talk to her about death or dying. The subject was not to be brought up. Her teenage granddaughter thought she was doing great. The family refused the input of the hospice social worker or chaplain but allowed a nurse to check in on her. When she became agitated, she was given medication to calm her down. It was as if a shameful and dirty secret was contained in the home. This is not a good dying time and it went on much longer than anticipated. As far as I know, there was no service planned. It was as if her dying was no big deal, which to me means her living was no big deal as well.

When someone has a terminal diagnosis and dying is in the house, it should be acknowledged with grace and humility. The moments should be a meditation on mortality and impermanence. Gentle music should be played. Candles should be lit. Visitors bearing flowers should be welcomed into the home. The truth of things should be discussed and the dying person should express his or her fears and concerns. Reassurance should be given by family that it is OK for their loved-one to die and that they will be able to carry on. Sometimes a dying person needs permission from their loved ones to die. Memories should be recalled. Apologies should be made. There should be laughter and tears. Perhaps a gathering of family and friends. Input from the dying person regarding his or her funeral service should be requested.

It is also possible to have a wake at home, bypassing the funeral industry. The deceased can be lovingly cared for by family and friends, his or her body delicately washed, then dressed and laid out. This is how it once was before funeral homes became the norm and we hired professionals. It is perfectly legal to not use a funeral home. A great resource for this is the National Home Funeral Alliance (NHFA). On its homepage it is written, "The NHFA empowers families to care for their own dead by providing educational opportunities and connections to resources that promote environmentally sound and culturally nurturing death practices (http://homefuneralalliance.org/).

There is no bigger deal than the dying time and death of our loved one. What is asked of us as survivors is to bear witness, and this can only be done if the truth of what is going on is acknowledged by all. We owe this to our loved one and we owe it to ourselves.

Deborah Golden Alecson is a death, dying and bereavement educator and speaker who resides in Lenox. She is the author of three books that deal with her personal loss. Learn more at deborahgoldenalecson.com.


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