Emotional, Psychosocial, Spiritual and Family issues

The end of life is an emotional time, where people are dealing with impending loss and grief. Relationships may be strained and patients may feel isolated. Patients may suffer from severe depression or be immobilized by fear. Counseling and support groups can be of great help to people who are facing the end of life.

Patients and/or families often have practical issues to deal with, such as financial difficulties, food preparation, cleaning, even getting the mail or paying bills. If patients have dependent children, they may have deep anxiety about what will happen to their children when they die, especially if there is no one else available to raise the children. Spouses may be unprepared to assume responsibility for home and family and feel desperate. Helping people to deal with these types of issues can be critical to their peace of mind.

Spirituality is sometimes difficult for healthcare workers to discuss with patients, but people may benefit from a visit from clergy or participation in the rituals related to their religion or belief system. People may experience a spiritual crisis as they try to deal with the reality of impending death. They may benefit from the opportunity to express their feelings.

There are major cultural and religious differences in the way people view the end of life. There are those that believe (for example, many Orthodox Jews) that everything should be done to prolong life, even at the expense of suffering. People in some cultures, such as traditional Japanese, believe that patients should be protected from the knowledge that they have a life-threatening illness. Some Buddhists believe that to relieve the pain of dying brings suffering in the next life.

Some people adamantly refuse to discuss the issue of death. Those who work with patients at the end of life need to question, learn and respect belief systems that are different from their own. They must try to relieve suffering as much as possible within the framework of the patient's beliefs. It's also good to remember that the trend toward speaking openly about death and end of life care is relatively new, and not everyone agrees that it is a positive thing.

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