Creating a Final Scenario
When given the chance, many adults would like to discuss a variety of issues, collectively called end-of-life issues: management of the final phase of life, after-death disposition of their body and memorial services, and distribution of assets (Green, 2008; Kleespies, 2004). How these issues are confronted represents a significant generational shift (Green, 2008). Parents and grandparents of the baby-boom generation spoke respectfully about those who had “passed away.” Baby boomers are far more likely to plan and be more matter-of-fact. People want to manage the final part of their lives by thinking through the choices between traditional care (e. g., provided by hospitals and nursing homes) and alternatives (such as hospices, which we discuss in the next section), completing advance directives (e. g., durable power of attorney, living will), resolving key personal relationships, and perhaps choosing the alternative of ending one’s life prematurely through euthanasia.
What happens to one’s body and how one is memorialized is very important to most people. Is a traditional burial preferred over cremation? A traditional funeral over a memorial service? Such choices often are based in people’s religious beliefs and their desire for privacy for their families after they have died.
Making sure that one’s estate and personal effects are passed on appropriately often is overlooked. Making a will is especially important in ensuring that one’s wishes are carried out. Providing for the informal distribution of personal effects also helps prevent disputes between family members.
Whether people choose to address these issues formally or informally, it is important that they be given the opportunity to do so. In many cases, family members are reluctant to discuss these matters with the dying relative because of their own anxiety about death. Making such choices known about how they do and do not want their lives to end constitutes a final scenario.
One of the most difficult and important parts of a final scenario for most people is the process of separation from family and friends (Corr et al., 2008; Wanzer & Glenmullen, 2007). The final days, weeks, and months of life provide opportunities to affirm love, resolve conflicts, and provide peace to dying people. The failure to complete this process often leaves survivors feeling that they did not achieve closure in the relationship, which can result in bitterness toward the deceased.
Health care workers realize the importance of giving dying patients the chance to create a final scenario and recognize the uniqueness of each person’s final passage. A key part of their role is to ease this process (Wanzer & Glenmullen, 2007). Any given final scenario reflects the person’s personal past, which is the unique combination of the development forces the person experienced. Primary attention is paid to how people’s total life experiences have prepared them to face end-of-life issues (Neimeyer, 1997).
One’s final scenario helps family and friends interpret one’s death, especially when the scenario is constructed jointly, such as between spouses, and communication is open and honest (Byock, 1997; Green, 2008). The different perspectives of everyone involved are unlikely to converge without clear communication and discussion. Respecting each person’s perspective is key and greatly helps in creating a good final scenario.
Encouraging people to decide for themselves how the end of their lives should be handled has
helped people take control of their dying (Wass,
2001) . Taking personal control over one’s dying process is a trend that is occurring even in cultures like Japan that traditionally defer to physician’s opinions (Hayashi et al., 2000). The emergence of final scenarios as an important consideration fits well with the emphasis on addressing pain through palliative care, an approach underlying hospice.