LEARNING OBJECTIVES

• What is a personal final scenario?

• What are hospices, and what options do they provide?

• How do people make their end-of-life intentions known?

J

ean is a 72-year-old woman who was recently diagnosed with advanced colon cancer. She has vivid memories of her father dying a long, protracted death in great pain. Jean is very afraid that she will suffer the same fate. She has heard that the hospice in town emphasizes pain management and provides a lot of support for families. Jean wonders whether that is something she should explore in the time she has left.

Where and how do most of us want to die? Ideally, most people would not like to die alone; indeed, this is one aspect of death anxiety (Kastenbaum, 1999). Whether death occurs in a hospital, hospice, or at home seems less important than having friends and family around. However, most of us do not get our wish. We are most likely to die surrounded by health care workers rather than family. The increasing institutionalization of death has two major consequences (Kastenbaum,

1999) . First, health care professionals are play­ing a more important role in dying people’s lives. Thus the medical staff is being forced to provide emotional support in situations largely antithetical to the main mission of healing and curing. This dilemma presents health care workers with prob­lems that we consider later.

A second important result of the institution­alization of death is that dying is being removed from our everyday experience. Not long ago, each of us would have known what it was like to interact with a dying person and to be present when someone died. Institutions isolate us from death, and some argue that the institutions are largely to blame for our increasing avoidance of death and dying people. Unfortunately, researchers cannot evaluate this opinion, because we cannot randomly have some people die at home and others die at hospitals, just to compare the effects of each in an experiment.

What we can do, though, is consider how we may be able to create a final scenario about our own deaths and explore options for end-of-life care. Let’s see what is involved in each.