I Am Not Afraid Of Death

Other than “when will I die,” one of the most frequent questions asked by patients and loved ones is a variation of “will I die in pain?” How much will I suffer along the way? One of the reasons the euthanasia movement gains any traction is the myth that dying is suffering and dying is painful is a powerful myth.

I still remember the Friday, May 5, 2023, admission of a patient with stage 4 Glioblastoma brain cancer where the patient was extremely intelligent, coherent, and concerned whether he would suffer during the dying process. His beloved family including his wonderful significant other shared similar concerns…. Is dying painful? Will there be suffering? Let me try to address this question of immense importance, and it is the answer to this critical question that puts me on the completely opposite side of any type of medically assisted suicide question.

How Hospice Can Help You Die Comfortably

Many people who are facing death or caring for a dying loved one have a common fear: will they die in pain? Will they suffer in their final moments? This fear is fueled by the misconception that dying is always painful and unbearable, and that the only way to avoid it is to end one's life prematurely. However, as a hospice nurse with years of experience, I can tell you that this is not true. In this article, I will share with you some of the facts and myths about dying, and how hospice can help you or your loved one die comfortably and peacefully.

What is Hospice?

Hospice is a type of care that focuses on improving the quality of life for people who have a terminal illness and a life expectancy of six months or less. Hospice provides medical, emotional, and spiritual support to the patient and their family, and helps them cope with the physical and psychological challenges of dying. Hospice does not aim to cure the disease or hasten death, but rather to make the dying process as comfortable and dignified as possible.

can be provided at home, in a hospice facility, or in a hospital, depending on the patient's preference and needs. Hospice care is covered by Medicare, Medicaid, and most private insurance plans, and is available to anyone who meets the eligibility criteria, regardless of age, diagnosis, or income.

What Causes Pain and Suffering at the End of Life?

Pain and suffering at the end of life can have different causes and manifestations, depending on the type and stage of the disease, the patient's medical history, and their personal and cultural beliefs. Some of the common sources of pain and suffering are:

  • Physical pain: This can be caused by the disease itself, such as cancer, or by other conditions, such as arthritis, that the patient may have had before the disease. Physical pain can be acute or chronic, and can affect different parts of the body. Physical pain can be treated with medications, such as opioids, non-steroidal anti-inflammatory drugs, or adjuvant drugs, which can relieve the pain or reduce its intensity. Physical pain can also be managed with interventions, such as massage, acupuncture, heat, cold, or distraction techniques, which can enhance the effect of the medications or provide alternative relief.
  • Shortness of breath: This can be caused by diseases affecting the lungs, such as COPD, or by other factors, such as fluid buildup, , or low oxygen levels. Shortness of breath can make the patient feel suffocated, panicked, or exhausted. Shortness of breath can be treated with medications, such as opioids, bronchodilators, or diuretics, which can ease breathing or reduce the fluid. Shortness of breath can also be managed with interventions, such as oxygen therapy, positioning, relaxation, or breathing exercises, which can improve the oxygen delivery or reduce the respiratory effort.
  • : This can be caused by diseases affecting the brain, such as dementia, or by other factors, such as medication side effects, electrolyte imbalance, or . can make the patient feel agitated, confused, or restless. Terminal can be treated with medications, such as antipsychotics, benzodiazepines, or sedatives, which can calm the patient or induce sleep. Terminal can also be managed with non-pharmacological interventions, such as music, aromatherapy, or , which can soothe the patient or address their emotional needs.
  • Air hunger: This is a rare but distressing symptom that can occur in the final hours or minutes of life, when the patient feels a severe and unrelenting urge to breathe, even though they are receiving enough oxygen. Air hunger can be caused by diseases affecting the brainstem, such as a stroke, or by other factors, such as , fear, or guilt. Air hunger can be treated with medications, such as opioids, which can reduce the sensation of breathlessness or the awareness of breathing. Air hunger can also be managed with non-pharmacological interventions, such as reassurance, presence, or spiritual support, which can comfort the patient or ease their existential distress.

How Can Hospice Prevent or Relieve Pain and Suffering at the End of Life?

Hospice can prevent or relieve pain and suffering at the end of life by providing a comprehensive and holistic approach to care which addresses not only the physical, but also the emotional, social, and spiritual aspects of dying. Hospice can help the patient and their family by:

  • Assessing the patient's symptoms and needs regularly and adjusting the treatment plan accordingly
  • Educating the patient and their family about the disease, the dying process, and the options for care
  • Providing the patient with effective and appropriate medications and equipment to manage their symptoms and enhance their comfort
  • Providing the patient with skilled and compassionate nursing care, personal care, and symptom management
  • Providing the patient with emotional and psychological support, counseling, and therapy to cope with their fears, anxieties, and grief
  • Providing the patient with social and practical support, such as assistance with daily activities, transportation, or financial issues
  • Providing the patient with spiritual and cultural support, such as chaplaincy, prayer, or rituals, to address their beliefs, values, and meaning
  • Providing the patient with opportunities for self-expression, creativity, and legacy, such as art, music, or writing, to share their stories, feelings, and wishes
  • Providing the patient with opportunities for connection, intimacy, and closure, such as family visits, phone calls, or letters, to say goodbye, express love, and resolve conflicts
  • Providing the patient with respect, dignity, and autonomy, such as honoring their preferences, goals, and decisions, and allowing them to die in their place of choice

Conclusion

Dying is not necessarily painful or suffering. With hospice care, dying can be comfortable and peaceful. Hospice can help the patient and their family experience a , one that is consistent with their values, wishes, and needs. Hospice can help the patient and their family live fully and meaningfully until the end. Hospice can help the patient and their family die with grace and dignity.

Resources

Understanding Hospice Care: Is it Too Early to Start Hospice?

What's the process of getting your loved one on hospice service?

Picking a hospice agency to provide hospice services

Medicare — Find and compare hospice providers

Two days… until….

A Good Death

Validation Therapy: A useful set of techniques to know

Differences between Delirium and Terminal Restlessness

Does everyone get pain when they are dying?

No, most people aren't in severe pain when they die

Myths About the Dying Process

Signs of Approaching Death by The Hospice Foundation of America

Is Natural Death Normally Painful?

What It Feels Like to Die: Science is just beginning to understand the experience of life's end

Is Dying painful? What happens when we are dying? by Hospice Nurse Julie

Hospice Does Not Euthanize

Providing Comfort During the Last Days of Life with Barbara Karnes RN (YouTube Video)

Preparing the patient, family, and caregivers for a “Good Death”

Velocity of Changes in Condition as an Indicator of Approaching Death (often helpful to answer how soon? or when?)

The Dying Process and the End of Life

The Last Hours of Life

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Gone from My Sight: The Dying Experience

The Eleventh Hour: A Caring Guideline for the Hours to Minutes Before Death

By Your Side , A Guide for Caring for the Dying at Home

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