We are created to live. The wish to LIVE seems to be rooted in our genes. Human beings may have no real perception of DEATH. But throughout human history there have been many expectations and hopes of what will happen after death. As human beings we are strongly dependent on each other
People approaching death can delay decease so as to allow relatives time to accept the inevitable.

Accompanying relatives, friends and professionals can give strength to those approaching death.
The patient is the most important person
The patient’s wishes are decisive and must be accepted even where this results in medical and nursing care different to that indicated by professional standards. E.g. a patient might refuse help from a medical professional he is not familiar with, irrespective of that this therapy would improve his symptoms. We should not worry about being too precise in our medical explanations. In my experience most seriously ill have an inner understanding about what is happening to them. This premonition is stronger than medical results (laboratory values etc.)
Developments are different
The effects of medical interventions are not objective and can differ in different patients. People approaching death can be thought of as having wounded bodies. Antibiotics, parenteral nutrition, blood transfusions etc, may have some short-term success to plug a few holes but the “life juices” will flow out somewhere else.
The soul decides the time of death
The recognition of a spiritual dimension helps to let confidence grow and to find peace. It makes sense to ask patients about their spiritual beliefs. This can be done in a sensitive manner at the first contact. In the end we are faced with the Truth. Evidence indicates that there is no possibility to delude oneself. The end does not have to be a smooth journey. Comparable to birth in some cases it might be quite “tousled”. (Both birth and death are messy and ultimately uncontrollable events.) It’s only important to make it.


Monika Windsor, specialized outpatient palliative care (SAPV) Berlin , Germany

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