Death and dying: how do we approach end of life in healthy ways?

Including Google's doodle celebrated the centennial of Dame Cicely Saunders life on June 22, 2018, this post originated with a philosopher's cafe.

2 years ago

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“Would you be surprised if this patient died within the next × months?”[1] Starting with a practitioner's SQ or surprise question, the context is a metaphorical spectrum of awareness. In varying degrees, we are all aware of the finitude of our lives. We will die, each, [pause] and every one of us. Life and Logos (literature in a literary sense - yuk!) run counterpoint to time[2]. As George Steiner describes in The Poetry of Thought (pg. 91); "The world literature edifice originates in epic, lives in tragedy and dies in comedy. The paradigm is that which unfolds from Homer to Sophocles and from Sophocles to Aristophanes." With this information, I liken the individual human outlook to a life bias with the subtle irony penetrating consciousness as the last scene approaches the same potential fate as the ephemeral and lost Attic tragedies.[3]

Average life expectancy for this Canadian is 80 years old. Oddly enough, Irony is the literary device at work here. Twenty-eight summers or winters is all that remains for this statistic and that is in fact, a cold stark reality on a summer thought. The healthcare Clinicians are often inaccurate at predicting End-of-life timelines.[1:1] End-of-life care refers to health care, not only of a person in the final hours or days of their lives, but more broadly care of all those with a terminal condition that has become advanced, progressive, and incurable.[4] Hospice is a type of care involving palliation without curative intent. Palliative Care encompasses mental health and life-limiting treatment, which seems to be unique to America. Why is that so? Libertarian ethics protect the narrative structure beneath the data point, apparently, this is also relational and cultural. Violations to individual liberties should be measured through definable data points, not around them. The definition of the point is the point, something that Euclid may have missed yet discussed in my 2018 discussion paper.[5]

As the end to your consciousness approaches, cell death is the final cause, a term borrowed from Aristotle, and then translated to describe the ultimate purpose for Being. For me, living is the ultimate purpose. What is "it" that is lost in translation? Bill Murray has no clue, he is an actor on a stage. Wait a minute, so are you! We are all living an illusion of sorts, for this is what we describe and translate from our senses to the material into the narratives that we tell ourselves and each other. 'Beyond the living' As the title preemptively primes, the conversation concerning death is universal and analogous to an analog clock, yet at some level it is discrete, deterministic and Einsteinian. I am not alluding to 'beyond the living' and I am not dismissing the quantum paradigm, the pendulum will shift to a state of neo-Newtonism or, I like to imagine imaging, a quaternion correlation of sorts, a conversation with The higher authority of the mathematics department.

Let's go to the palliative points because after all this pensée (contemplative/reflective thought) is intended to describe approaching end of life in healthy ways. Why do we refer to this non-living state as, "end of life", versus [simply] death? Death appears to be impregnated with implicit fear narratives, drivers that have driven the autonomous agents we call ego to the brink of social "salvation". Cheekiness aside, the own-ness falls on you to decide for yourself, because as Albert Camus famously said, “There is only one really serious philosophical question, and that is suicide”[6]. To that end, the flock remains and life goes on with or without you until such time as it doesn't. This is the solution to the hard problem of consciousness. Problem solved. Fact found. Is this a discovery of sorts or a pedestrian attempt to circumvent the question? No coercion, philosophical inversions or semantic love-loss aversion at play here, just the forme of an ideal, proof through abstraction as the Ancient Greeks taught us. There are some grounds for the Aristotelian here, simple cell death is a resounding NO! The ultimate protest to living is fallacious in its ontology. Refuting ontology as something material is simply to do, it's a fiction. Is that in dispute? It was Hannah Arendt that referred to Martin Heidegger as, " secret king of thought." So how is that Adorno's materialism is compatible with Heidegger's ontology? Continental philosophers stay tuned or read the sophist at work and how the Continental Divide Unifies: The Compatibilism of Adorno and Heidegger.

Anyone, including the public masses as an entity, will follow from a starting position of vulnerability. Tit-for-tat in Game Theory tells us so. Oppression prompts reactionary language, expired abundance prompts the language of entitlement. Consumption is the key. What are you consuming? More importantly, will it sustain you, will it sustain future generations? Don't give your conscience the cold shoulder. I am talking to you! That's right if you hear voices other than your own that is schizophrenic, otherwise, that's your ego speaking. Mindfulness is one path to distance yourself, frontal cortical myelination is another.

Dame Cicely Saunders believed that everyone should live with “a sense of fulfillment and a readiness to let go.”

Google's doodle celebrated the centennial of Dame Cicely Saunders life on June 22, 2018. Saunders' name necessarily follows education of the palliative subset of hospice in the history of this progressive approach to End-of-life care. "A sense of fulfillment and a readiness to let go", is a watershed moment of consciousness, heightened only by socially incremental or different interpretations of the ethics of living.


Saunders' favourite anthology, All in the End is Harvest: An Anthology for Those who Grieve is as the title suggests. Digging deeper, this "sense of fulfillment and "readiness to let go", begins and ends with the möbius that is Julian of Norwich: "love is not changed by death, and nothing is lost, and all, in the end, is harvest".

In terms of Hospice classification, care focuses on five topics: communication, collaboration, compassionate caring, comfort, and cultural (spiritual) care. The end of life treatment in hospice differs from that in hospitals because the medical and support staff are specialized in treating only the terminally ill. This specialization allows for the staff to handle the legal and ethical matters surrounding death more thoroughly and efficiently with survivors of the patient. Hospice comfort care also differentiates because patients are admitted to continuing managing discomfort relief treatments while the terminally ill receiving comfort care in a hospital are admitted because end-of-life symptoms are poorly controlled or because current outpatient symptom relief efforts are ineffective

Hospice is a type of care involving palliation without curative intent. Usually, it is used for people with no further options for curing their disease or in people who have decided not to pursue further options that are arduous, likely to cause more symptoms, and not likely to succeed. Hospice care under the Medicare Hospice Benefit requires that two physicians certify that a person has less than six months to live if the disease follows its usual course. This does not mean, though, that if a person is still living after six months in hospice he or she will be discharged from the service.

The philosophy and a multi-disciplinary team approach are similar to hospice and palliative care, and indeed the training programs and many organizations provide both. The biggest difference between hospice and palliative care is the type of illness people have, where they are in their illness especially related to prognosis, and their goals/wishes regarding curative treatment.

Outside the United States there is generally no such division of terminology or funding, and all such care with a primarily palliative focus, whether or not for people with a terminal illness, is usually referred to as palliative care.

It seems to me that palliative care outside the United States does not delineate between Hospice and Palliative (need to find out if this is indeed true - look at references on the "Palliative care" and "Hospice care" Wikipedia pages). This is an interesting development considering the development of the language into categories of care and institutions structured around these ethics. Questions in the delineation between Palliative versus Hospice philosophies could pivot around a non-pejorative understanding of segregation as compassion towards the familiar. Implicit to admission, What are you in for? is the second philosophical question.

Outside North America, the term hospice usually refers to a building or institution which specializes in palliative care, rather than to a particular stage of care progression. Such institutions may predominantly specialize in providing care in an end-of-life setting, but they may also be available for people with other specific palliative care needs.

  1. AMA White N, Kupeli N, Vickerstaff V, Stone P. How accurate is the 'Surprise Question' at identifying patients at the end of life? A systematic review and meta-analysis. BMC Med. 2017;15(1):139. Published 2017 Aug 2. doi:10.1186/s12916-017-0907-4 ↩︎ ↩︎

  2. Continental philosophers may point to Adorno for a refutation of 'perspective' or 'position', whereas dialectic differs with capitalization and ideology (ie. Marx versus Socratic). I will not refute or discuss the coupling and decoupling of time to reality, this is an advanced philosophical position or dialectic (depending on your intellectual and philosophical pedigree). ↩︎

  3. The missing Attic Tragedies haunt us because we know they were written yet unknown. ↩︎

  4. Wikipedia Article and Definition of End-of-life - Accessed Feb 12, 2019 - ↩︎

  5. Sanderson, Daniel, Defining the Euclidean Point (a discussion), planksip publishing, ISBN: 978-1-7750571-1-6 ↩︎

  6. Aronson, Ronald, "Albert Camus", The Stanford Encyclopedia of Philosophy (Summer 2017 Edition), Edward N. [^N] (ed.), URL = ↩︎

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Published 2 years ago