ars moriendi

The Art of Dying was simple at one time, in the long history of man. You were born, you lived, you died and this was the accepted course of your life. Medical doctors were sparse and medications were few. Solutions were not readily available foe whatever might ail you. Granted some people did not live long lives, however, their lives were lived within the family unit and their life had purpose until the end. Was there fear? yes. Was there pain? yes, however, most were stoic in managing to keep their pain to themselves to “spare” their loved ones.

In the medieval version, which was published in Latin, people thought death “should be accepted stoically, without fear of-or self-pity or hope for anything more.” Other matters to attend to were asking God for forgiveness, reaffirming one’s faith, repenting one’s sins and letting go of one’s worldly possessions and desires were crucial. The families were advised to pray and to ask questions of the dying so that they would be in the right frame of mind when death arrived. Last words, according to The Art of Dying, were precious and were words of reverence to hold in the sacred places of your heart.

Is this the way we approach death today? No. The main prescription, when given a diagnosis of a terminal illness, is lots of options with the main one being Hope. Doctors Hope that one of the options will extend your life and many have extended lives for years, however the end is always the same The years left after a terminal diagnosis could be better charted, in my opinion, if the patient were asked certain questions by a very sensitive, experienced person in hospice care. The questions to be answered by the patient, according to Dr. Gould as written in Being Mortal by Atul Gawande are:

  1. Do you want to be resuscitated?
  2. Do you want aggressive treatments such as intubation and mechanical ventilation?
  3. Do you want antibiotics?
  4. Do you want tube or intravenous feeding if you can’t eat on your own?

Having an advanced directive makes it easier for everyone, even though having one does not mean that Hope has been abandoned. Yet, without the answers to these questions the family may not know what you would want for your life and chaos can cost minutes of time that could have been spent saying “I love you” and saying goodbye.

There are so many differing opinions on this subject and so much information “out there” that it is difficult to plow through the research and find what will work for you. Yet, in the end, after all the clinical trials, the “options”, when they all run out, will you ask yourself if the quantity of time you spent with your loved one and the pain endured was worth all the “options” pursued or would you rather have spent quality time at the end and lived each minute in the moment?

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