Is it possible for a terminally ill person to flourish? New research from the Australian Catholic University says yes—and there may be aspects of the good life that are uniquely meaningful as it draws to a close.
While a person at life’s end may experience a decline in their agency and ability to act, crises and illnesses can provide the opportunity to bring our life’s story to a coherent conclusion.
A more holistic approach to palliative care could see practitioners guide the patient through therapies that help them draw their life into a narrative, reconcile with family members, and come to terms with suffering and adversity.
Paradoxically, this might mean that with the right care, as a person comes to terms with death, they have the chance to “get better” in those aspects of life that have historically been regarded as most central: harmonious relationships, peace with God and the world, and preparing for a “good death.”
The paper “Flourishing at the end of life” was published in the journal Theoretical Medicine and Bioethics by lead author Dr Xavier Symons, director of ACU’s Plunkett Centre for Bioethics, with Australian and US co-authors in the fields of philosophy and medicine.
“We do not wish to romanticise the dying process and the pain and suffering that typically accompany it,” they write.
“But … we would like to put pressure on an assumption that some might hold, namely, that flourishing is impossible or exceedingly rare in the final chapters of life.”
“When someone knows that they have two, six, or twelve months to live, they often give increased focus to what they deem to be most important,” the authors continue.
“Whereas previously, certain pragmatic goals such as reaching professional performance indicators may have been the focus of one’s energies—even to the detriment of one’s overall wellbeing—when time and perhaps physical and mental capacities are limited, one may focus less on these goals and instead give attention to other goals, such as the cultivation or restoration of close familial relationships or spiritual and religious engagement.”
As Australian deaths from “voluntary assisted dying” grow in number, Dr Symons hopes further empirical research into therapies that focus on the meaningfulness of the end-of-life may help fewer people feel compelled to end their own lives.
“Definitely I would hope that this approach would reduce the number of people who feel they need to seriously consider VAD as an end-of-life option,” Dr Symons told The Catholic Weekly.
“Hopefully everyone agrees that it’s probably better that people don’t have to choose VAD.
“Hopefully there’s enough sanity in the debate for people to say, ‘OK, essentially committing suicide at the end of life is not an ideal outcome … having to get to that point, feeling compelled to take that kind of radical action.’
“The ways in which we say people can flourish at the end of life paradoxically have as their catalyst points of crisis.
“The idea you could find meaning in suffering is so profoundly counter-cultural today, that it’s assumed to be not even worth considering even by a lot of people who think about the issue of euthanasia.”
Dr Symons and his co-authors consulted doctors in end-of-life care settings about their challenges, while preparing the paper.
His impression is that that palliative care practitioners are not necessarily focused on the kinds of clinical interventions his research recommends, but a conversation is already taking place within palliative care about the whether the discipline can offer more than just physical comfort to the dying.
“We talk about things like legacy work, spiritual care interventions, dignity therapy, forgiveness interventions, relationship counselling—the list goes on,” he said.
“There’s broader spiritual and religious support patients can receive if they’re part of a religious tradition.
“There’s many things we can do to help patients reconnect with other family members, from whom they’re maybe estranged.
“You can help patients heal at the end of life in such a way that although their health is declining, from the perspective of whole-person care they’re actually getting better in some aspects of their personhood and relationships.
“That’s where we’re pushing with the paper: to try to give a renewed impetus to a conversation that’s already been taking place in palliative care about the importance of not just comfort, or the absence of pain at the end of life, but also notions of flourishing.”
