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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