Terminal Illness and Death

Today, through the application of science, we have a technology of great benefits and comprehensive implications. We can map the surfaces of neighboring planets, split the atom and the DNA molecule, and more on it recent advancements in modern medical technologies have increased the hope and life-span expectancies of people. However, inherently each of us is still a purely weak creature with a desire for meaning. We may have challenged the powers of God with our science, but we remain individually constrained by our innate emotional needs, frightening dependencies and terrifying vulnerabilities. The human fate is so fragile, as we daily see accidents, illnesses and deaths. Nothing is precious to us than our lives but each and every one of us has to leave this world. What happens when one is about to leave the world? According to the psychologist Erik Erickson (1959), every individual passes through eight stages of psychosocial development. He classifies the final stage as "Integrity vs. Despair". At this stage, the individual is engaged in life review and preparation for the end-of-life. This writing is focuses on the feelings of dying, in terms of experience of loss, psychosocial issues, and sexual and affection considerations.

Taking in consideration the experience of loss, faced by the dying, death is the ultimate loss and through the dying process we gradually suffer physical, social and psychological depletion. Physical losses begin with the deterioration of health. Illness weakens the body over a period of time. The gradual loss of body image can cause great suffering. People spend lifetimes integrating their perception of their own physical appearance with their perception of how others view them. People who are taking medications during their terminal phase often have facial swelling/puffiness, weight loss or gain, hair loss, and other physical changes. These changes may bring a little more painful awareness of how much the person has changed in appearance. The dying face loss in another area, their relationships; friends and family who not know how to deal with the person will often find it convenient to stay away. And those who shows their concerns initially, will stop calling or visiting one by one. Whatever the reasons, their abandonment hurt deeply. Along with this the most painful loss might be the lost of personal future. According to Feifel and Branscomb(1993), “Humans are unique in being able to grasp the concept of a future”(p.81). No future means no relationship, no role, no possessions, no being. The thought itself is overwhelming and frightening. What will my children and spouse do with out me? Who will take over my place? What will happen to my things? Someone who is going to die will have all these questions in their mind.

. In addition to these losses face by a dying, there are a variety of psychosocial issues that they experience. Since people have no first-hand experience with death, the dying process itself is often feared. According to Gray (1981), “Most people have a greater dread of the process of dying than they do of death itself”(p.15). Many people as well as their families want to know how the person will die because of their fear that death will be horrible and painful. A major concern for persons is where they want to be when they die. Some prefer to be at home surrounded by family and friends. Others prefer to be alone in order to not burden their loved ones. The person also experience hope along with fears. This may include a hope for another birthday; to see a child graduate or marry etc. It is a fact that with out hope life has a very little meaning. The dying also have some needs at that time, for instance a need to wind up the unfinished business, a need to mend a broken relationship, a need to transfer the property and wealth through own will. These needs are all part of getting one’s house in order. At that time the person needs to have a strong and meaningful support.

Along with the psychosocial issues, of importance is sexuality and affectional consideration. In our cultural situation it may look awful to address the sexuality of a dying, but sexuality has its own importance during terminal phase. The person may need more love and affection at that time than a healthy one. What is sexuality? Of course it is more than the act of intercourse or physiological characteristics that represent gender. Our sexuality is essential to our beings; it is a basic need and an aspect of humanness that can not be separated from the rest of life. Sexual adjustment and fulfillment are enhanced by a close, loving relationship with another person: In our culture usually a husband/wife. Close and loving relationships with their implications create feelings of fulfillment and meaning in life. Therefore dying process has an impact on the dying person as well as their relationship. In fact, those who are dying should also be treated as sexual beings.

In summary, the dying experiences a series of losses during the period of their final illness. Changes in body image, roles, relationships and sexuality all creates emotional concerns for the dying person and those who are closed to them. They also have fears. The fear of abandonment and the fear of pain are almost universal. We need to understand feelings about loss and fear. We also need to understand our own feelings in order to be more comfortable with death. The care of the dying person should include opportunities for that individual to develop and maintain a sense of worth and integrity as well as a sense of control, completion, resolve, and closure. This includes multi-dimensional/holistic care, including physical, psychosocial, and spiritual care.

References

Bosch, L. et.al, (2005).The role of the nephrology social worker in end-of-life issues. Retrieved on April 02, 2006 from http// www.ikidney.com

Feifel, H., and Branscomb, A. (1993). Who’s afraid of death? Journal of abnormal psychology. 81:282.

Gray, R. (1981). Some physiological needs: In dealing with death and dying. (p.15) Horsham.