This lesson will present the case of Judy, and provide information regarding the perspective that attitudes towards dying vary across individuals and are influenced by culture and faith traditions—an important consideration in Canada’s multicultural society.
It will also give you tools for effective communication with patients and their loved ones about exploring the benefits of opting for palliative care, as well as the potential costs to a patient and their family if difficult conversations are avoided. A self-reflection exercise will also encourage you to think through your own feelings and beliefs about dying and death.
In this video, you will consider the types of conversations that may occur between patients and their families when medical professionals are not there to witness them.
(To read along click here.)
As healthcare providers working with palliative care patients, we are often coming into a person’s life at a later stage, and they already have their network of relationships established. What we bring is medical knowledge, an awareness of the process of dying and death, and an interest in maintaining clear communication through all of the changes that will come.
The Role of Culture
In the previous video, we saw how one of Judy’s friends reacts to her news: with a determination to fight, and the attitude that ‘anything is possible’. This may be seen as a great way for her to support her friend, but it is also a reflection of a dominant Canadian cultural behaviour to deny death as much as possible.
The Ottawa-based Vanier Institute of the Family has an excellent resource on “Death, Dying and Canadian Families” by Dr. Katherine Arnup1. She discusses common attitudes to dying and death in Canada, beginning with the notion that Canadian society is death-denying—deeply uncomfortable with the reality of death, and deeply uncomfortable talking about issues related to dying and death. With the historical shift to the medicalization of death in Canada (and other Western countries), it is easier to ignore the reality of death: gone are the days when every funeral was a community event and when even children grew up interacting with people who were dying.
Consider the following “realities” of dying and death. Despite the fact that the majority of people hope to die at home, the majority of people die in a hospital or long-term care facility. Many people do not want “heroic measures” taken once they are incurably sick, but most people have not told their doctor or a loved one this. In fact, most people do not have an Advanced Care Directive in place. An Advanced Care Directive is a document with written instructions regarding future decision-making about one’s health care, including who will make decisions for them once they are unable to make decisions on their own due to illness or incapacity, and what care they would like to receive in that situation. It is very important that individuals talk both with the people they want to authorize as substitute decision-makers and with their healthcare providers about their wishes. See here and here.
In the Canadian context, pain management and dignity are two primary concerns for those who are dying. Palliative care can offer excellent services to address both these concerns, but discussing palliative care (as with many other issues surrounding dying and death) is difficult. Even healthcare providers struggle to start such conversations with patients and their families. Palliative care’s emphasis is on the life of the patient, for as long as they live—and accepting death as the way each life ends. This requires a shift in thinking for many people.
Of course every person is unique, and there are lots of individuals and families in Canada who draw much more from their cultural or religious background, especially when important life events an transitions occur.
Take some time to reflect on your own culture’s attitudes to dying and death in the following exercise.