Personal thoughts about death

As Joe Gibes referred to in his 1/17/14 post, it is easy for those of us who discuss and write about bioethics to talk about death in academic terms that leave out the personal and emotional context that death involves. On 1/11/14 my wife Rachael’s mother died after many years of dementia and 5 months of having metastatic ovarian cancer. There were no ethical dilemmas involved in her death. Her husband of 65 years cared for her in their home with the help of a hospice team. She had little pain until the last few weeks and that was well controlled by their care. The decision by her surrogate decision makers to provide palliative care for her incurable cancer was not a difficult decision to make. Yet her death makes me think about some of the things we discuss in a new way.

Rachael’s mother was at peace with her death. Even though her dementia caused her to forget to she had cancer and she woke each day with the sense that she had been ill, but the conviction she was getting better, she did understand briefly when her condition was explained to her that it meant she was going to die. Her response to that was that she was ready to go to be with her Lord whenever it was time. Death was something that she had faced as a reality ever since she had been expected to die as a child of tuberculosis and lived the rest of her life with the respiratory after-effects of that. Her faith in God was strong and she was fully assured of her future life freed from the limitations of this life. Death is an enemy, but it is a defeated enemy and she knew that. Those of us in medicine who have this Christian understanding of death still see death as an enemy which we work to prevent when possible, but we need to remember that our ability to thwart death is limited and it is Christ who has ultimately defeated death.

Rachael’s father is also a man of faith who shared his wife’s understanding that Jesus had defeated death and is looking forward to eternity with his Lord, but the death of his wife of 65 years tore a hole in his heart. He had spent the past 7 years or more devoted to caring for her and her needs as her ability to care for herself gradually was taken away by her dementia and then more rapidly by her cancer. This strong man who had held up others in their struggles for decades as a pastor was broken. Tears flowed whenever he tried to speak. My wife was impacted in the same way. Suddenly with her mother’s death her whole world had changed. She knew intellectually that it was coming, but the impact was overwhelming. As we gathered as a family and many prayed those broken hearts began to be mended, but it will take a long time for hearts that have been torn apart by the death of this precious woman to heal. When we in medicine care for those who are dying it is right for us to be guided by the decisions and values of the one who is dying and when that person is incapable of making decisions the decisions about care should be made according to the best interest of the dying person and in light of that person’s values, but we need to be careful to remember that it is not only the person who is dying who is impacted by death. We need to remember the impact that death has on those who love the one who is dying and extend our care to them. The hospice movement includes that perspective in what they do and we all need to be sensitive to the needs of those who are left behind.

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