One of the fundamental goals of health care and palliative care has been to encourage everyone to accept the inevitability and normality of eventual death and to understand the limits of state-of-the-art technology to lengthen our lives with quality.
- We want everybody to accept the fact that they will die including every member of their family.
- We tell them the truth as they approach the end of their life that there are so many things that we can do to lessen the physical suffering that they may experience.
- We acknowledge the fact that we cannot guarantee to relieve all symptoms.
- We reassure patients that we will help them all feel safe and look after them and their families whatever happens.
- We provide support to deal with a complex mix of emotional, psychological, social, and spiritual concerns we may face.
- We strive to help patients set aside any fears that they may have of being dead.
Decades of biological and cultural evolution have taught us how to grieve, and we do stop people from undergoing normal grief. Experience loss and tackle the tasks of mourning when it happens are the price of the bonds that are necessary for the success of families and communities.
We can become quite good at it by dint of our knowledge, skills, a projection of our personality and attention to detail. Some of our patients are being at peace in the company of the people they love and in a comfortable environment and able to die serenely with their symptoms controlled having attained an accommodation with the common end of their life.
Having embraced our guidance and normalized patient death and dying, it is not surprising that we may find ourselves feeling faced by patients. This is the reason why we were hinted at that warm summer evening viewing the Catch-22.
During World War II, Yossarian Heller’s character was a United States airman based in Italy. He realized that people were trying to kill him because he was trying to bomb them, so he was driven to a state of paranoia. The military response that the mere fact of asking for release on the grounds of insanity was because of people attempting to kill him; catch-22, so he could not be sent home.
We are destined to find that we are building a conundrum for ourselves as we progressively become victorious in our efforts to support people to set aside culturally-induced fears of being dead, our patients and their families not different from that faced by Yossarian.
A number of our patients have no fear of being dead with or without our help. Some conclude that they do not wish for more time being at peace and content with the quantity and quality of their life. A small proportion of patients may want to exercise what they believe to be their right to choose their time to die for those whose life expectancy is short and who accept the reality of their imminent death. They proclaim that they are ready for the end of their life and wish to die now when encouraged to exercise their autonomy and empowered by the ethos of patient-centred care.
According to Catch-22, The presumption that they want to die is the most common response of the culture of health care, and such victims must be suffering from some form of existential distress and depression. When you encourage a patient to achieve peace with their imminent death, they are likely to be surprised and disappointed, but we then say they cannot do what a logical consequence of there, having realized the goal we have set for them is. They do not have the capacity to being subjected to a contemporary version of Catch-22 based on the circular argument that they choose to end their life.
No argument against the appropriate management and identification of existential distress or depression. Patients could accuse us of paternalism or materialism, or even illogicality if we block the demands of patients who can decide on their own.
We are unable to control the beliefs and values of our patients in this increasingly secular and multicultural society. Considering how to respond to dying and contented patients who wish medical assistance in dying, without assuming that their actions or requests mean that they must be feeling existential distress may be one of the consequences of our success in promoting acceptance of the normality of death. Our patients have been helped to achieve existential peace with our provision of high-quality palliative care using alternative constructs.