Do or Die: Healing Care at the End of Life

Elaine O'Brien, PhD, MAPP '08, is a positive psychology, fitness leadership, positive health promotion, movement science, aging, and well-being speaker, author, trainer, thought leader, people/project manager, educator, and consultant. Elaine creates programs promoting proactive positive health/fitness, and optimal performance. Elaine presents internationally and online. She advances health, fitness, and flourishing by inspiring people to move more and to find both enjoyment and meaning in motion via PEP: Positive Exercise Practices. Elaine's website.  Full bio. Elaine's articles are here.

Summer Palace

Primitive man’s reaction to death was one of fear. Today, man still reacts to death with fear. Death is still an unknown. Man naturally fears what he does not understand and cannot control. We cannot know exactly what death is, so we can’t fully understand it. Much of our response to death is avoidance.

“Have courage for the great sorrows of life and patience for the small ones; and when you have laboriously accomplished your daily task, go to sleep in peace.” Victor Hugo

Death is not a pleasant topic. Talking about death on a personal level often creates discomfort. A conversation about the end of our own life is sensitive and complex, if brought up at all. However, without exchanges about end-of-life issues, there is confusion, which adds a psychological, spiritual, and financial burden for those dying, and their families. Our failure to address these concerns can lead to greater suffering.

Talking Strategies to Create a Virtuous Feedback Loop

A Fallen Tree

Palliative care, a field that lies between curing disease and entering hospice, is a misunderstood discipline. Physician David Wallenstein of UCLA’s Palliative Care Service wants people to know they have alternatives. Dr. Strouse, also UCLA, complains, “Health care reimbursements tend to favor high-tech and procedure orientations like surgery and endoscopy, over the less dramatic, like spending time talking.”

Wallenstein and Strouse believe this strategy needs to change as, “Every day dying patients are marginalized, even discriminated against by doctors who pull back when they feel nothing more can be done.” Palliative care can help prevent futile and/or unwanted intensive care. Palliative care is a source of hope and relief.

Dr. Chris Feudtner

Dr. Chris Feudtner, specialist in pediatric palliative care, discusses the importance of our valuing emotions outside of decision-making and problem solving. “Harnessing our emotions during life’s challenging times,” he asserts, “offers a means of:

• Assessing value by providing raw data about what matters
• Coloring Meaning by providing affective dimensions in narratives
• Bestowing Value by projecting from us onto people or situations
• Forging Motivation by harnessing the neurophysiology of our will.”

SPEC versus DRAIN

Isaac Prilleltensky

Isaac Prilleltensky and Ora Prilleltensky focus on the development of compassionate, quality, affordable care. Their philosophy builds a research/training foundation designed to optimize the interaction between psychological wellness, organizational, and community health.

Just as they view the current medical system as sick care rather than health care, they’ve coined the acronym DRAIN for the method often used around health decisions. DRAIN is costly, because it is:

• Deficit oriented – often stuck in what is lacking
• Reactive – as opposed to proactive and planning ahead
• Arrogant – in giving over our power or sense of self to others
• Individualistic –not looking at the big picture of the person in a family and community context
• Negative – not broadening or building, but disapproving and unresponsive

They propose an alternative, SPEC, that can promote family well-being:

• Strength
• Prevention
• Empowerment
• Community Change

Healing Practices inspired by SPEC include:

• Building positive resources by strengthening and cherishing bonds with family and friends
• Practicing meditation. The study by Christopher Brown and Anthony Jones shows meditation reduces anticipation of pain, as well as negative judgments about pain.
• Saving other lives by becoming an organ donor.
• Creating an ethical will in addition to a living will
• Writing letters of gratitude.
• Being open to awe and wonderment.
• Journaling your legacy.
• Enjoying the power of your favorite music.
• Telling people you love and care for how special and important they are to you.
• Cultivating compassion and an understanding of our interconnectedness.

Spirituality as a Preventative Measure

Dr. Harold Koenig

At the University of Pennsylvania symposium “Religion, Spirituality and Health in Older Adults,” Dr. Koenig from Duke University, discussed spirituality as a preventative measure. Koenig believes greater peace is a major goal for patients and families. He discussed taking a patient’s Spiritual History, a spiritual assessment in order to address sensitively religious background, beliefs, or rituals that could be relevant to health care. Koenig believes, “Spiritual struggles can adversely affect health outcomes,” and “Enhanced doctor/patient relationships can offer more positive outcomes.”

Dr. Andy Newberg discussed the importance of meditation, and how it helps our brain stave off age-related losses. His work links theology and neuroscience. Here is a mantra-based meditation from Newberg:

• Sa (birth)
• Ta (life)
• Na (death)
• Ma (rebirth)

George Valliant makes the case for spirituality as a positive force in human evolution. He asserts, “Over the long term, having love for all people, and compassion for all religious beliefs, will reflect a cultural evolutionary advance.” In considering the evolution of empathy and thoughts of greater fulfillment, Valliant considers:

• Our life purpose – by our consideration of objective goals and subjective fulfillment
• Our values – in our justification of certain courses of action
• Our efficacy – in the belief that we can make a difference
• Our self-worth – in believing that we are valuable

“Knowledge replaces fear.” Mrs. Ratel, Health teacher, the Henley School

Looking Ahead

The first of 76 million U.S. Baby Boomers turned 65 on January 1, 2011. About 10,000 Baby Boomers, born between the 1946 and 1964, will turn 65 every day for the next 17 years. For the first time in history, humans are looking forward to a life expectancy that’s higher than any previous generation. This new era will impact boomers, as well as their parents, children, and grandchildren.

In aiming for flourishing in the world, Positive Psychologists will continue to inspire others in the direction of a wiser, greener, more mindful, peaceful, virtuous, sustainable, harmonious planet. Isn’t it also sensible, noble, and real for us to share our hopes, concerns, and fears about our mortality? Can we talk? Could that also be our legacy?

References:

Brown, C. A. & Jones, A. K. P. (2010). Meditation experience predicts less negative appraisal of pain: Electrophysiological evidence for the involvement of anticipatory neural responses. Pain, 150 (3), 428-438. Abstract..

Feudtner, C. (2005). Hope and the Prospects of Healing at the End of Life. Journal of Alternate and Complementary Medicine. 11:1, S23-S30.

Easing Life’s Final Choices: Palliative Care in The Korea Herald. Article about Dr. Wallenstein

Lee, B. Y. & Newberg, A. (2005). Religion and Health: A Review and Critical Analysis. Zygon, 40 (2), 443-468.

Prilleltensky, I. & Prilleltensky, O. (2006). Promoting Well-Being: Linking Personal, Organizational, and Community Change. Hoboken, NJ: Wiley.

Vaillant, G. (2008). Spiritual Evolution: A Scientific Defense of Faith. New York: Broadway Press.

Duke Center for Spirituality, Theology, and Health

More information on Organ Donation

UCLA’s Palliative Care Service

National Palliative Care Research Center, UK

Images
Dying Leaf courtesy of Jenny Downing
A Fallen Tree courtesy of h.koppdelaney
Donate Life imageg from organdonor.gov