Only the man who does not fear death is not a slave". Montaigne
Human beings have needs that vary according to circumstances (health, illness, nearness of death) and the priority that each person gives them. Despite these individual factors, however, it is still possible to make some generalizations.
As the end approaches a person's needs change. New needs may appear, while previous needs are often viewed differently.
Needs when healthy:
- Basic: breathing, eating, sleeping, clothes, shelter, absence of pain,...
- Social: feeling protected from danger, loved by family or group, accepted and respected, privacy.,...
- Transcendental: respecting one's way of thinking.
Whether framed by philosophical or religious considerations or not, everyone has something that we can call a 'wisdom of life'. These 'wisdoms of life' should be respected; they are all equally valid. They should all be offered, but never imposed through threats or promises.
Needs when ill:
Sick people feel threatened by the changes taking place in their lives.
-They fear the physical consequences of illness, the pain, isolation, incapacity, loss of well being, loss of autonomy, loss of emotional equilibrium and separation from family.,...
- Leaving behind their home for the cold and unfamiliar environment of a hospital causes even greater anxiety.
Needs when dying:
- The previously mentioned needs must all be addressed. Where appropriate, special attention should be given to key issues such as pain relief.
- The more vulnerable a person becomes, the easier it is to become depressed and anxious. It is precisely at times like these, when people are most in need of support, that they are left to fend for themselves.
- Most people agree that it is better to be honest and open about terminal illnesses, and that the sick should be able to stay at home surrounded by their loved ones. When the dreaded moment comes, however, people often act differently. Lies, silence, and looking the other way become the order of the day during the dying person's final days.
- A vicious circle develops. The relatives of dying people pretend that it is better if the sick are not informed of their condition, while at the same time realizing that they already know the truth. The dying see the truth in our faces and gestures, in the way we try to manage conversations and in the absurd answers we give to their questions. Meanwhile, the sick say nothing because they see the pain talking about their condition causes others.
- Hospitals do not handle this situation any better. There are no trained professionals to cover this necessity. We must be clear that this is a necessity. No one should be surprised to learn that in the absence of professional help the dying often turn to fellow patients, cleaning staff or hospital attendants for support and conversation in their moments of greatest need.
- We must face the fact that society is hypocritical about death. A more honest attitude to something that one day will affect us all would be beneficial for everyone.
- We need to look for better ways of dealing with this issue.
- At present, the only thing most people do for the dying is attend their funeral when they have died.
- Unfortunately, this is a subject that those in high positions have no interest in. Looking after real needs and developing whole people would weaken the control they hold over the public.
1-Not feeling alone:
It is important that the dying person not feel alone. If there is conversation so much the better, but what is most important is simply being with these people. Pretty words are not necessary, only sympathetic company.
2-Feeling listened to:
Let the dying speak. Listen. It may not be necessary to speak much at all. Dying people may need to ask you questions that they often ask themselves; questions that reveal their feelings and anxieties. They may ask things such as: "Do you think my sins will be pardoned?"
Sometimes they claim a dead person has visited them or that they have seen God or a saint. Statements of this kind are not a result of medication or insanity. Although there are many theories that attempt to explain this phenomenon, there is at present no accepted scientific explanation. In any case, it is in no one's interest to dispute the truth of these claims. What is important is to reduce the anxiety that the dying experience at this time.
Do not bother them with questions of the type: 'Do you know who I am?' If they understand the question, but are unable to respond (a not infrequent occurrence), you will only succeed in making them feel even more distressed.
If we are frightened by death, we will not be able to reduce the anxiety that dying people feel. You must come to terms with the situation first.
Get used to the idea of death. It is as natural as life itself. Get rid of your fears. Facing death without fear is the goal.
If you do not know what to do, try praying. Pray to whatever you consider to be holy. It may be something that has produced positive feelings in you during your life. It could be a god, a saint, a Buddha, nature, or a kind person you knew who has died,...
You can be sure that the dying person will respond to the positive feelings produced by this praying. At this time love, tenderness and sincerity are what are required above all else,...
At the same time you will notice that you are uplifted by the feelings you receive from the other person. This sensation of communion between two people is a beautiful moment, a time to feel one's humanity.
Many times dying people console the living, give advice, or even trying to make sure that their deaths will not cause too much unhappiness. The dying often give messages of peace and emphasize the truly important things in life.
Emphasize what the dying have achieved and done well. Help them to feel useful and satisfied with their lives. Praise their virtues and ignore their defects.
In these moments we become more sensitive to feelings of guilt and depression. For this reason we must concentrate on giving hope of any kind so that people can face death in the most serene state of mind possible.
Encourage the dying to settle any ongoing disputes with family and friends. Help them to eliminate all feelings of hate. If asking for forgiveness in person is impossible, suggest writing a letter or making a video recording.
If this idea is not accepted, do not press the issue. The most important objective at this time is to reduce anxiety levels.
6-Rekindle the dying person's "wisdom of life":
Praise the dying person's "wisdom of life"; do not try to convert people to your own philosophy of life. Some ingenuity is called for in finding out what motivates people; everyone is different and what motivates people is as varied as people themselves. It may be saying a prayer for a Christian, reciting a mantra for a Buddhist, remembering Allah for a Muslim, mentioning the next union with nature for a shaman or just telling an atheist that everything will be all right,...
Give the dying whatever they are looking for; never impose values on them.
7-Do not "kill" the dying before their time:
The dying are terminally ill, but not stupid. We should involve them in decisions that affect them and their families. To help them feel useful, we should consult them about what they want to eat, whom they want to be visited by, even purchases or sales that need to be made. In general, they should be allowed to participate in all matters in which they show interest.
Sometimes people are 'killed' by their relatives. When the terminally ill realize they are a burden on their families, or hear relatives fighting over the inheritance, or are constantly being urged to show more willpower, they often give up and decide to die.
8-Dealing with last wishes:
Everything possible should be done to meet the dying people's wishes. Whatever reasonably can be done should be done to ensure that they do not die with unfulfilled wishes.
A simple example is arranging a final visit to an old friend. Or someone wishing to visit a particular country or place. If it is not possible to make visits of this kind, showing the person a television program or putting a poster of the place in the room could be a beneficial alternative.
In other cases last wishes can involve sorting out things such as pensions or mortgages,...
9-The dying continue to have basic needs:
When death is looming on the horizon, we sometimes forget the basics.
The dying are better off at home, surrounded by their possessions and loved ones. A clean (do not use bleach or strong smelling products because the mucous membranes in the nose become more sensitive as conditions worsen), well-ventilated, sunny room with flowers is always best.
Visits should be short and only allowed if desired. Do not strain the sick. Do not force the dying to hold your hand. Let them decide how much physical contact they desire. Put your hand under theirs and let them withdraw it when they want.
Never forget the human touch, even if the person is in coma. We do not know how much these patients are aware of what is happening around them. It is not unknown for those who have been in coma for many months, with no apparent awareness of their condition, to regain consciousness shortly before death. In some cases these people have taken the hand of the nurse who was kindest to them, even calling her by name and saying goodbye.
Do not force people to eat. The dying's dietary requirements are not the same as ours. Give them what they ask for. They usually prefer hot, light meals, such as soups and purées.
Follow doctor's instructions about pain relief medication, posture (it is easier to breathe on your side than face-up), complications that may arise, etc,...
Do not whisper within earshot of the sick. They will hear and will assume the worst. If you need to talk, leave the room.