End of Life: A Terminal Illness and Death Journey

Introduction

In healthcare, professionals are aware of the complicated process when patients go through the process of dying and the reaction of both terminally ill patients and their families. Frequently, the family takes the responsibility of deciding for the patients who no longer have such capacity. As a result, before accepting their condition, end-of-life decisions put much pressure on terminally ill patients and additionally pose a challenge to friends and relatives as they often refuse to stop medical support.

Perspective of Patients

The perspective of patients in terms of death can be explained by Kubler-Ross’s five stages of grief theory, which shows the transition to the acceptance of the terminal disease. The denial stage is frequently characterized as “a state of shock” (Grief, n.d.). During this phase, patients frequently feel numb and refuse to believe the outcome of the disease (Corr, 2020). For instance, Norman is among the incapacitated patients who have a debilitating illness. As his sister mentioned, despite being incapable of either moving or talking, “he wants everything to stay alive” (Kirk & Smith, 2010, 30:58). Norman refuses to believe that he will not recover and hopes that at least one treatment will help him. The next stage is anger, which can be characterized as the feeling of unfairness and deep pain (Tyrrell et al., 2021). For instance, John Maloney was 55 when he was diagnosed with multiple myeloma, and he tried every treatment. However, he was admitted to the hospital, and he further claimed that several days before the incident, he “was in good shape”, and later, he felt “like somebody shot [him]” (Kirk & Smith, 2010, 35:41). Feeling healthy one day and then suddenly becoming helpless the other made the man feel betrayed and angry with his condition. John Maloney additionally illustrates the stage of bargaining, asking himself the what-if question. In John’s situation, the man claims that even the condition in which he is right now is better than being dead, and he is ready to undergo chemotherapy or transplants. According to his wife, he always said one phrase, such as “I’m going to do this, and we’re going to have time,” and it was his mantra (Kirk & Smith, 2010, 23:40). Thus, the man had no desire to accept the terminal disease and the fact that he was dying. However, unlike the previous stage, when patients refuse to accept reality, the next stage, depression, is focused on the given condition. This is the moment when the individual’s “attention moves squarely into the present,” and they have to face the terms of their disease (Grief, n.d.). Alber Alberti is a 53-year-old man diagnosed with a type of leukemia named MDS. After having a stroke, he became emotional and claimed that “it wears at you, these diseases” (Kirk & Smith, 2010, 20:58). The final stage is acceptance, the moment when patients understand that their death is inevitable and they must emotionally brace themselves. Diana Reed, a 31-year-old woman diagnosed with scleroderma, which causes the skin to tighten. She expressed her decisions regarding end-of-life treatment and “told doctors that she did not want to be permanently dependent on machines” (Kirk & Smith, 2010, 10:20). Therefore, one can see that Diana did not refuse to accept her condition and decided to prepare for her death.

Perspective of Healthcare Personnel

The perspective of healthcare personnel is based on both the support of the patients and the continuous search for treatments and options. The first stage, denial, is viewed by many doctors as a phase when they have to support the patients. According to Adriana Malone, “stopping treatment almost means that we acknowledge that the death is near” (Kirk & Smith, 2010, 34:45). However, another specialist mentioned that the following stages as just as stressful for professionals as it is for clients. Keren Osman claims that while they “do make them suffer, […] there is a greater good at the end of it” (Kirk & Smith, 2010, 18:36). Similarly, at the stage of bargaining, patients seek ways to minimize mortality. For instance, Celia Grosskreutz says that many patients ask their doctors about their chances of survival, “but even when the numbers are low, they still go for it, because the option of living is worth it” (Kirk & Smith, 2010, 22:14). Therefore, at the stage of bargaining patients will always seek ways to become healthy again. Still, there is always a significant amount of uncertainty when it comes to the terminal condition of a patient. David Muller emphasizes the complicated stage of depression and accentuates that if “there is almost always something else that we can do to put off the inevitable,” specialists strive to incorporate it (32:17). Finally when there are almost no chances of survival, patients have to admit their dying and so do specialists. Eileen Scigliano from the bone marrow transplant department mentions that “the mortality from the transplant can be 25-30% from the treatment”, and there is always a struggle (Kirk & Smith, 2010, 19:42). Consequently, during the final stage, specialists face the reality of neither treatment nor other methods will yield results.

Perspective of Family

Lastly, the perspective of the family can be based on more emotions since they experience struggles for themselves and their close ones. In the beginning, the audience can see the denial of Diana Reed’s family, and despite doctors’ prognosis, the family member replies the following: “Right now I want to keep her the way she is, on the respirator” (Kirk & Smith, 2010, 11:22). During another stage, the family might express their anger with the condition (Corr, 2019). Marthe Laurevilleis’s daughter still hopes that her mother diagnosed with dementia, will become well. As she mentions, she does not “want to be the one to say DNR and to be responsible for her death before her time” (Kirk & Smith, 2010, 13.49). Similarly, during the stage of bargaining, the family will strive to find ways to heal the patient, such as Alber Alberti’s wife, who says that they must “take every step possible” (Kirk & Smith, 2010, 21.56). Here, they hope that one treatment will help the patient. The stage of depression from the perspective of the family is mixed with pain for their loved ones and themselves. According to Robert Bernadiniis’s wife, Julia Romero, she does not “know what to do about this”, and she does not “want him to suffer anymore” (Kirk & Smith, 2010, 8:51). Finally, in the beginning, one can see the family saying goodbye to their loved one, Gendolina Lara-Morillo, and when the doctor says that “she’s not doing well, she’s dying,” the family accepts it (Kirk & Smith, 2010, 2:18). Thus, similarly to others, the family undergoes the five stages of grief as well.

Conclusion

In conclusion, end-of-life decisions put a lot of strain on terminally ill patients before they accept their situation and provide a problem to friends and family as they frequently refuse to quit providing medical treatment. Terminally ill patients undergo five stages of death when they first refuse to admit their dying process and, in the end, prepare for it and make their final decisions. According to specialists, this process can be as stressful for healthcare providers as it is for patients since they strive to find any treatment that could work. Finally, close ones undergo five stages of grief when they deny their loved one dying and, in the end, refuse to see them suffer.

References

Corr, C. A. (2020). Elisabeth Kübler-Ross and the “five stages” model in a sampling of recent American textbooks. OMEGA-Journal of Death and Dying, 82(2), 294-322. Web.

Corr, C. A. (2019). The ‘five stages’ in coping with dying and bereavement: strengths, weaknesses and some alternatives. Mortality, 24(4), 405-417. Web.

Grief. (n.d.). Five stages of grief. Web.

Kirk, M., & Smith, M (Writers). (2010). Frontline [Television broadcast]. PBS.

Tyrrell, P., Harberger, S., & Siddiqui, W. (2021). Stages of dying. StatPearls Publishing. Web.