The duty of "perjury" in relation to incurable and dying patients was deontological (from the Greek. Deon - duty, logos - word, doctrine) the norm of Soviet medicine. The doctor's right to "perjury" in order to ensure the right of a terminally ill person to ignorance was seen as a feature of professional medical ethics in comparison with universal human morality.
This feature is based on quite serious arguments. One of them is the role of the psychoemotional factor of belief in the possibility of recovery, maintaining the struggle for life, preventing severe spiritual despair. Since it was believed that the fear of death brings death closer, weakening the body in its struggle with the disease, the message of the true diagnosis of the disease was considered tantamount to a death sentence. However, there are cases when a lie did more harm than good. Objective doubts about the well-being of the disease outcome cause anxiety in the patient and distrust of the doctor. Attitudes and reactions to illness in patients are different, they depend on the emotional and psychological makeup and on the value and worldview culture of a person.
Is it possible to open a diagnosis to a patient or family member? Maybe we should keep it a secret? Or is it advisable to provide the patient with a less traumatic diagnosis? What should be the measure of truth? These questions will inevitably arise as long as there is healing and death.
Currently, Russian specialists have access to numerous foreign studies of the psychology of terminal patients (terminus - end, limit). The conclusions and recommendations of scientists, as a rule, do not coincide with the principles of Soviet deontology. Investigating the psychological state of terminal patients who learned about their terminal illness, Dr. E. Kubler-Ross and her colleagues came to the creation of the concept of "death as a stage of growth." This concept is schematically represented by the five stages through which a dying person (usually an unbeliever) goes. The first stage is the "stage of denial" ("no, not me", "this is not cancer"); the second stage is “protest” (“why me?”); the third stage is "asking for a delay" ("not yet", "a little more"), the fourth stage is "depression" ("yes, I am dying"), and the last stage is "acceptance" ("let it be") ...
The stage of "acceptance" is noteworthy. According to experts, the emotional and psychological state of the patient at this stage changes fundamentally. The characteristics of this stage include such typical statements of once prosperous people: "Over the past three months I have lived (a) more and better than in my entire life." Surgeon Robert Mack - a patient with inoperable lung cancer, describing his experiences - fear, confusion, despair, finally states: “I am happier than I have ever been before. These days are now actually the best days of my life. " One Protestant priest, describing his terminal illness, calls it "the happiest time of my life." As a result, Dr. E. Kübler-Ross writes that “she would like cancer to be the cause of her death; she does not want to lose the period of personality growth that terminal illness brings with it. " This position is the result of realizing the drama of human existence: only in the face of death does a person discover the meaning of life and death.
The results of scientific medical and psychological research coincide with the Christian attitude towards a dying person. Orthodoxy does not accept perjury at the bedside of a hopelessly sick, dying person. “Hiding information about a serious condition from the patient under the pretext of preserving his mental comfort often deprives the dying person of the possibility of conscious preparation for death and spiritual consolation obtained through participation in the sacraments of the Church, and also darkens his relationship with relatives and doctors with distrust.”
In the framework of the Christian worldview, death is the door to the space of eternity. A fatal illness is an extremely significant event in life, it is preparation for death and reconciliation with death, it is an opportunity to bring repentance, to pray to God for the forgiveness of sins, it is deepening into oneself, intensive spiritual and prayer work, it is the exit of the soul into a certain new qualitative state. Therefore, it is unlikely that an Orthodox person will be surprised by the prayers to God of Elder Porfiry from the monastery in Milesi about sending him a cancer disease and about his joy in the disease, given to him at his request.
On this occasion, Abbot Nikon (Vorobyov, † 1963), one of the spiritual elders of our century, once wrote that cancer, from his point of view, is God's mercy to man. A person doomed to death renounces vain and sinful pleasures, his mind is occupied with one thing: he knows that death is already close, already inevitable, and only cares about preparing for it - reconciliation with everyone, correcting himself, and most importantly - sincere repentance before God. Revealing the content and meaning of the Christian understanding of the perniciousness of perjury, the meaning of illness and death, becomes for many Russian doctors the basis for revising the deontological norms of Soviet medical deontology. Metropolitan Anthony of Sourozh, himself a doctor in the past, believes that it is necessary to draw the attention of modern doctors to the fact that during the course of an illness (we are talking about incurable diseases) a person must be prepared for death. At the same time, Vladyka Anthony says: "Prepare the dying not for death, but for eternal life."
Claiming that a doctor's attitude towards incurable and dying patients cannot be simply scientific, that this attitude always includes compassion, pity, respect for a person, a willingness to alleviate his suffering, a willingness to prolong his life, Metropolitan Anthony of Surozhsky draws attention to one “unscientific "Approach - on the ability and" willingness to let a person die. "
In 1992, the Council of Bishops of the Russian Orthodox Church canonized Grand Duchess Elizabeth Feodorovna (widow of Grand Duke Sergei Alexandrovich, son of Emperor Alexander II, who was killed by a terrorist in 1905). In 1909, she created the Martha and Mary Convent of Mercy in Moscow, where she was not just an abbess, but participated in all her affairs as an ordinary nurse of mercy - she assisted in operations, did dressings, consoled the sick, believing at the same time: “It is immoral to console the dying with a false hope for recovery, it is better to help them in a Christian way to pass into eternity. "
Kalinovsky P. Transition. // The last illness, death and after. Ekaterinburg, 1994.S. 125.
Fundamentals of the social concept of the Russian Orthodox Church. // Newsletter of the DECR of the Moscow Patriarchate. 2000. No. 8, p. 82.
Monk Agapius... Divine flame kindled in my heart by Elder Porfiry. M .: Publishing house of the Sretensky Monastery, 2000.S. 56.
Metropolitan Anthony of Sourozh. Healing the body and saving the soul. // Man. 1995. No. 5.P. 113.
A person's life path ends with his death. You need to be prepared for this, especially if there is a bedridden patient in the family. Signs before death for each person will be different. However, observation practice shows that it is still possible to identify a number of general symptoms that portend the nearness of death. What are these signs and what should you prepare for?
How does a dying person feel?
Lying patient before death, as a rule, experiences mental anguish. In a healthy mind there is an understanding of what is to be experienced. The body undergoes certain physical changes, this cannot be overlooked. On the other hand, the emotional background also changes: mood, mental and psychological balance.
Some people lose interest in life, others completely close in themselves, others can fall into a state of psychosis. Sooner or later, the condition worsens, a person feels that he is losing his own dignity, more often thinks about a quick and easy death, asks for euthanasia. These changes are hard to observe without being indifferent. But you have to come to terms with this or try to alleviate the situation with drugs.
With the approach of death, the patient sleeps more and more, showing apathy towards the world around him. In the last moments, there may be a sharp improvement in the condition, reaching the point that the patient who is lying down for a long time is eager to get out of bed. This phase is replaced by the subsequent relaxation of the body with an irreversible decrease in the activity of all body systems and attenuation of its vital functions.
Lying patient: ten signs that death is near
At the end of the life cycle, an elderly person or a bedridden patient increasingly feels weak and tired due to a lack of energy. As a consequence, he is increasingly in a state of sleep. It can be deep or drowsiness through which voices are heard and the surrounding reality is perceived.
A dying person can see, hear, feel and perceive things and sounds that do not exist in reality. In order not to upset the patient, this should not be denied. Loss of orientation is also possible and the Patient is more and more immersed in himself and loses interest in the surrounding reality.
Urine, due to kidney failure, darkens to an almost brown color with a reddish tint. As a result, edema appears. The patient's breathing quickens, it becomes intermittent and unstable.
Under pale skin, as a result of impaired blood circulation, dark “walking” venous spots appear, which change their location. They usually appear on the feet at first. In the last moments, the limbs of a dying person grow cold due to the fact that the blood, pouring from them, is redirected to more important parts of the body.
Failure of life support systems
There are primary signs that appear at the initial stage in the body of a dying person, and secondary ones, indicating the development of irreversible processes. Symptoms may be outward or latent.
Disorders of the gastrointestinal tract
How does the bedridden patient react to this? Pre-death symptoms associated with loss of appetite and changes in the nature and volume of food consumed are manifested by problems with stool. Most often, constipation develops against this background. It becomes more difficult for a patient without a laxative or enema to empty the intestines.
Patients spend the last days of their lives refusing food and water altogether. Don't worry too much about this. It is believed that dehydration in the body increases the synthesis of endorphins and anesthetics, which to some extent improve overall well-being.
Functional disorders
How does the patient's condition change and how does the bedridden patient react to this? Signs before death associated with weakening of the sphincters, in the last few hours of a person's life, are manifested by fecal and urinary incontinence. In such cases, you must be ready to provide him with hygienic conditions, using absorbent underwear, diapers or diapers.
Even with appetite, there are situations when the patient loses the ability to swallow food, and soon water and saliva. This can lead to aspiration.
With severe exhaustion, when the eyeballs are very sunken, the patient is not able to completely close the eyelids. This has a depressing effect on others. If the eyes are constantly open, the conjunctiva must be moistened with special ointments or saline.
and thermoregulation
What are the symptoms of these changes if the patient is a bedridden patient? Signs before death in a weakened person in an unconscious state are manifested by terminal tachypnea - against the background of frequent respiratory movements, death rales are heard. This is due to the movement of mucous secretions in the large bronchi, trachea and pharynx. This condition is quite normal for a dying person and does not cause him suffering. If it is possible to lay the patient on his side, the wheezing will be less pronounced.
The beginning of the death of the part of the brain responsible for thermoregulation is manifested by jumps in the patient's body temperature in the critical range. He may feel hot flashes and sudden coldness. The limbs are freezing, the skin covered with perspiration changes color.
Road to death
Most patients die quietly: gradually losing consciousness, in a dream, falling into a coma. Sometimes it is said about such situations that the patient passed away on the "usual road". It is generally accepted that in this case, irreversible neurological processes occur without significant deviations.
A different picture is observed with agonal delirium. In this case, the patient's movement to death will follow the "difficult road". Signs before death in a bed patient who embarked on this path: psychoses with excessive agitation, anxiety, disorientation in space and time against the background of confusion. If at the same time there is a clear inversion of the cycles of wakefulness and sleep, then for the patient's family and relatives this condition can be extremely difficult.
Delirium with agitation is complicated by a feeling of anxiety, fear, often turning into the need to go somewhere, to run. Sometimes it is speech anxiety, manifested by an unconscious stream of words. A patient in this state can only perform simple actions, not fully understanding what he is doing, how and for what. The ability to reason logically is impossible for him. These phenomena are reversible if the cause of such changes is identified in time and it is stopped with medication.
Pain sensations
Before death, what symptoms and signs in a bedridden patient indicate physical suffering?
Typically, uncontrollable pain rarely gets worse in the last hours of a dying person's life. However, this is still possible. An unconscious patient will not be able to let know about it. Nevertheless, pain is believed to be excruciating suffering even in such cases. The sign of this is usually a tight forehead and deep wrinkles appearing on it.
If, when examining an unconscious patient, there are suggestions of developing pain syndrome, the doctor usually prescribes opiates. You should be careful, as they can accumulate and over time exacerbate an already severe condition due to the development of excessive overexcitation and seizures.
Giving help
A bedridden patient may experience considerable suffering before death. The relief of symptoms of physiological pain can be achieved with drug therapy. Mental suffering and psychological discomfort of the patient, as a rule, become a problem for the relatives and close family members of the dying person.
An experienced doctor at the stage of assessing the general condition of a patient can recognize the initial symptoms of irreversible pathological changes in cognitive processes. First of all, these are: absent-mindedness of attention, perception and understanding of reality, the adequacy of thinking when making decisions. You can also notice violations of the affective function of consciousness: emotional and sensory perception, attitude to life, the relationship of the individual with society.
The choice of methods to alleviate suffering, the process of assessing the chances and possible outcomes in the presence of the patient in individual cases can serve as a therapeutic tool in itself. This approach gives the patient a chance to really realize that they are sympathetic to him, but perceived as a capable person with the right to vote and choose possible ways to resolve the situation.
In some cases, a day or two before the alleged death, it makes sense to stop taking certain medications: diuretics, antibiotics, vitamins, laxatives, hormonal and hypertensive drugs. They will only aggravate the suffering, give the patient inconvenience. Painkillers, anticonvulsants and antiemetic drugs, tranquilizers should be left.
Communication with a dying person
How should one behave in a family with a bedridden patient?
Signs of impending death can be explicit or conditional. If there is the slightest prerequisite for a negative forecast, you should prepare in advance for the worst. By listening, asking, trying to understand the patient's non-verbal language, one can determine the moment when changes in his emotional and physiological state indicate the imminent approach of death.
Whether the dying person will know about it is not so important. If he realizes and perceives, it makes the situation easier. You should not make false promises and vain hopes about his recovery. It must be made clear that his last will will be fulfilled.
The patient should not remain isolated from active affairs. It is bad if there is a feeling that something is being hidden from him. If a person wants to talk about the last moments of his life, then it is better to do it calmly than to keep silent about the topic or criticize silly thoughts. A dying person wants to understand that he will not be alone, that he will be taken care of, that suffering will not touch him.
At the same time, relatives and friends need to be ready to show patience and provide all possible help. It is also important to listen, to give a voice and say words of comfort.
Medical assessment
Do I need to tell the whole truth to relatives, in whose family the bedridden patient before death? What are the signs of his condition?
There are situations when the family of a terminally ill patient, being in the dark about his condition, literally spends their last savings in the hope of changing the situation. But even the most flawless and most optimistic treatment plan may fail. It so happens that the patient will never get back on his feet, will not return to active life. All efforts will be in vain, spending will be useless.
Family and friends of the patient, in order to provide care in the hope of a speedy recovery, quit their jobs and lose their source of income. In an effort to alleviate suffering, they put the family in dire financial straits. Relationship problems arise, unresolved conflicts due to lack of funds, legal issues - all this only aggravates the situation.
Knowing the symptoms of inevitably approaching death, seeing irreversible signs of physiological changes, an experienced doctor is obliged to inform the patient's family about this. The knowledgeable, realizing the inevitability of the outcome, they will be able to focus on providing him with psychological and spiritual support.
Palliative care
Do relatives need help, in whose family there is a bedridden patient before dying? What are the patient's symptoms and signs suggesting that she should be treated?
Palliative care for a patient is not aimed at prolonging or shortening his life. Its principles include the assertion of the concept of death as a natural and logical process of the life cycle of any person. However, for patients with an incurable disease, especially in its progressive stage, when all treatment options have been exhausted, the question of medical and social assistance is raised.
First of all, it is necessary to apply for it when the patient no longer has the opportunity to lead an active lifestyle or there are no conditions in the family to ensure this. In this case, attention is paid to alleviating the suffering of the patient. At this stage, not only the medical component is important, but also social adaptation, psychological balance, peace of mind of the patient and his family.
A dying patient needs not only attention, care and normal living conditions. For him, psychological relief is also important, the relief of feelings associated, on the one hand, with the inability to self-service, and on the other, with the awareness of the fact of the inevitably imminent imminent death. Trained nurses are proficient in the art of alleviating such suffering and can provide significant assistance to terminally ill people.
Scientists estimate death predictors
What to expect for relatives who have a bedridden patient in their family?
The symptoms of the approaching death of a person "eaten" by a cancerous tumor have been documented by the staff of palliative care clinics. According to observations, not all patients showed clear changes in the physiological state. One third of them did not show symptoms or their recognition was conditional.
But in most terminally ill patients, three days before death, a noticeable decrease in the response to verbal stimulation could be noted. They did not respond to simple gestures and did not recognize the facial expressions of the staff communicating with them. The “smile line” in such patients was lowered, an unusual sounding of the voice was observed (groaning of the ligaments).
In some patients, in addition, there was hyperextension of the cervical muscles (increased relaxation and mobility of the vertebrae), non-reactive pupils were observed, the patients could not close their eyelids tightly. Of the obvious functional disorders, bleeding in the gastrointestinal tract (in the upper sections) was diagnosed.
According to scientists, the presence of half or more of these signs may most likely indicate an unfavorable prognosis for the patient and his sudden death.
Signs and popular beliefs
In the old days, our ancestors paid attention to the behavior of a dying person before death. Symptoms (signs) of a bed patient could predict not only death, but also the future prosperity of his family. So, if a dying person asked in the last moments for food (milk, honey, butter) and relatives gave it, then this could affect the future of the family. There was a belief that the deceased could take wealth and luck with him.
It was necessary to prepare for imminent death if the patient shuddered violently for no apparent reason. It was believed that she looked into his eyes. Also, a cold and pointed nose was a sign of close death. It was believed that it was his death that kept the candidate in the last days before his death.
The ancestors were convinced that if a person turns away from the light and lies facing the wall most of the time, he is on the threshold of another world. If he suddenly felt relief and asked to be put on his left side, then this is a sure sign of imminent death. Such a person will die without suffering if the windows and doors in the room are opened.
Lying patient: how to recognize signs of impending death?
Relatives of a dying patient at home should be aware of what they may face in the last days, hours, moments of his life. It is impossible to accurately predict the moment of death and how everything will happen. Not all of the symptoms and ghosts described above may be present before the death of the bedridden patient.
The stages of dying, like the processes of the birth of life, are individual. No matter how hard it is for relatives, you need to remember that it is even more difficult for a dying person. Close people need to be patient and provide the dying person with the maximum possible conditions, moral support and attention and care. Death is the inevitable outcome of the life cycle and cannot be changed.
We come to the third main question: how to prepare for death? Meditation is a wonderful way to strengthen the mind and heart in anticipation of this test. But the very moment of death can be truly creepy.
Let's dwell on this in more detail and turn to the analogy of sailing on a rough river. To overcome the most dangerous river rapids, professionals train persistently, so as not to get lost among rocks, streams and waterfalls.
It is one thing to imagine death, and quite another to remain calm at the moment of leaving this life. In order not to lose your head when you meet such a threshold, you need to learn to feel the water, or, as Carlos Castaneda's teacher, don Juan advised, always "feel death over your shoulder." A reminder of the need to prepare for death and constantly think about it can be allegorical (for example, falling autumn leaves remind of it) or completely unambiguous, like the inscription on a tombstone I saw in New England:
I was just like you, passerby, But you will die one day too. Know: it will be with you too. Get ready to follow me.
According to a widespread misconception, preparing for death degrades our quality of life. In fact, this is not the case. During my work with the dying, I was repeatedly convinced that, sitting at someone's deathbed, I felt especially alive. When Marcel Proust, the great connoisseur of human comedy, was asked by a newspaper reporter how people should behave in the world's threatening catastrophes, he said the same:
1 Marcel Proust (1871-1922) - French writer, author of the cycle of novels "In Search of Lost Time", in which the inner life of a person
It seems to me that if we are facing death, life will suddenly seem wonderful. Think how many projects, travels, novels, lessons passed by us due to the fact that we lazily postponed everything for later, being sure of a safe future.
But if all these threats disappeared forever, how wonderful it would be! ABOUT! If there is no cataclysm, we will not miss the opening of the new exhibition in the Louvre, we will fall at the feet of Miss X, we will go to India.
Cataclysm does not happen, and we do nothing of this, returning to normal life, the negligence of which deprives the desire of the fragrance. And yet, to love life today, we don't need disasters. It is enough to remember that we are human beings and that death may come to us tonight.
Proust means that the lack of awareness of our mortality does not allow us to perceive life as fully as we feel it in the face of imminent death. Death, like love, breaks the line between us and the Secret, with the result that the grip of the ego weakens and the consciousness of the soul manifests itself.
In your life, you should make an effort to consciously accept the gift of death. You need to train your mind and heart to identify with the light of truth, and sharpen your attention so that it does not dissipate even in the moment of the greatest confusion. To cross the border of life easier, you have to throw a lot overboard. It is necessary to settle your relations with the living and the departed. It is not necessary to physically contact the person with whom we are connected; rather, we need to untie the knots on the threads of our ties in our heart. Ask yourself an important question: "Do I want to die with this stain on my mind?" You will almost always answer "No." Death provides a unique opportunity to see the dramas of the ego in their true light. Few problems are worth taking them with you to the next world. By taking a rigorous inventory of our unnecessary attachments, we prepare for a quiet departure.
You need not only to sort out your relationships with other people,
depicted as a stream of consciousness.
but also to put things in order - in the legal, medical and financial sense. If you do not want physicians to maintain life in your body at any cost, or if you want to place the vital organs of your dead body at the disposal of physicians (for transplantation or research), sign the "Will of Life" 1. The will should indicate what method of handling your dead body you prefer: burial or cremation. At the same time, it is advisable to discuss these details with those who will fulfill your wishes.
The need for such a consultation was clearly demonstrated to me by the death of my aunt. My father's younger sister was a wayward woman with a rebellious nature. When at sixty-something she was diagnosed with a brain tumor, she demanded that she, contrary to the laws of Judaism, be cremated. She died, her wish was granted, and the family wanted to bury her ashes next to other deceased relatives, but the cemetery administration resisted - it was a Jewish cemetery. A serious problem arose, which was resolved as follows: in the middle of the night, my uncle and aunt, with a lantern, a shovel and an urn, climbed over the cemetery fence, dug a small hole in the family plot, put ashes there, covered their tracks and ran away. They were not caught, but, in principle, they could have been in serious trouble.
Some people find it difficult to make a will. There is a superstitious idea that a person will not die until he expresses his last will. This way of thinking can create problems for those we leave behind. My father was a lawyer and I often heard from him about family and friends who fell out over litigation. The conscious aging program requires us to try not to harm anyone with our dying and death. We need to show the utmost concern for those who continue to live after we leave. This attention to material affairs is part of our spiritual practice and symbolizes the final renunciation of worldly power.
It is also important to decide where we would like to die. This is one of the most
1 "Will of life" - a document indicating what kind of medical care its compiler would like (or would not like) to receive in case of serious illness or disability.
important decisions, and it is desirable to make it before the onset of the crisis. Do we want to die in a hospital where all the attention is focused on medical care - or at home? How can we fill the room in which we are dying with a spiritual atmosphere so that it can help us remain conscious and facilitate our departure? For example, in Japanese Buddhism of "pure land" 1 it is customary to place an image of a heavenly abode by the bed of a dying person so that it is on it that a person can concentrate at the moment of leaving.
You know, Rich, I think I'm dying.
I think so too, ”I replied. She asked:
What do you think death is like?
We talked a little about this and I said:
You seem to me like someone who is in a house that is crumbling. But our connection seems to be independent of home. You will continue to exist even when your body is gone. And our connection will also remain.
She said she felt the same way. We were in this together
1 "Pure land" (jodo) and "truly pure land" (jodo-shin), or amidaism, which arose in the XII century. the current in Japanese Buddhism, which consists in worshiping the lord of the promised "pure land" (the world of deities and righteous people) Amida Buddha (Skt. Amitabha) and the constant repetition of his name.
psychological space just as much as it took to understand this truth - just a moment - but such a unity greatly comforted us.
The mother asked the doctors to allow her to return home from the hospital. She wanted to be back in her room. In the end, they reluctantly agreed, and the ambulance brought Mom home. It was quite obvious that after ten years of fighting the disease, she was now dying. The last time I saw her was before I flew to California, where I was to lecture on Sunday at the Santa Monica Civic Center. Although I had not hoped to see my mother again, at that time the obligation to the organizers of the lecture seemed more important to me than being at the bed of the dying. Today I would have made a different decision, but I was young and ambitious, and now I have to live with the memory of my deed.
Mother stayed at home for only one day, after which the doctors decided that she was too weak, and, despite her requests, transported their patient back to the hospital. My father, who found it very difficult to accept death, relied on the opinion of professionals: "Doctors know best." I knew that it was wrong, that it was necessary to give my mother the opportunity to die where she felt more free, but I felt the pressure of those values \u200b\u200bthat I did not share, and I was afraid to remain in the minority. So I said nothing. Mom was again taken to the hospital, and the next night she died alone in a mechanized intensive care unit, separated from her grandchildren (who were not allowed to go there) and from her beloved home.
In the years since my mother's death, a hospice movement has taken shape in our country. For those whose illness or loneliness prevents them from dying at home, hospice is a good alternative to a hospital. At the heart of the hospice concept is a more enlightened view of death as a natural process that should not be interfered with by certain medical methods. For those of us who want to consciously approach death, a hospice whose staff is free from the mindset of keeping the body alive at all costs can be a wonderful place.
Many people are involved in the work of hospices who deeply understand the significance of the process of dying and try to spiritualize it.
I would not like to cast a shadow on doctors and hospitals. Work
medical professionals, most of whom have dedicated their lives to the deeply spiritual (although they themselves may not be inclined to use the word "spiritual") to the idea of \u200b\u200balleviating suffering, it is difficult to overestimate.
Moreover, many hospitals are relaxing their rules, giving the patient more freedom.
In the seventies, ten years after the death of my mother, I visited the sick Debi Matesen, wife of Peter Matesen. Debi was dying of cancer in one of the buildings of the Mountain Sinai Hospital in New York. In New York, she visited a Zen center, and monks began to come to her room to meditate and help prepare for the moment of leaving. In one corner, they set up a small altar, and when they began to sing, the hospital room turned into a small temple. Once, when Debi had monks, during a round, doctors dropped in to see her - with their folders, stethoscopes, professional cheerfulness and the question: "Well, how are we doing?" But the spiritual atmosphere in the ward was so strong that the doctors stopped rooted to the spot, swallowing the end of the phrase, and quickly retreated in confusion! To leave the body, Debi was able to prepare such a sacred space, over which even starched white robes had no control.
Although dying at home in a familiar environment is much calmer, sometimes such an environment makes it difficult to leave. The presence of loved ones and objects can influence dying. Not wanting to hurt loved ones, a person wants to stay with them, despite the fact that nature requires otherwise. Because of this, a painful internal struggle can occur in the heart of a dying person: the soul seeks to leave, and the ego clings to life. We need to remember this when our loved ones die and when our turn comes.
I was told of a 28-year-old woman named Michelle who was dying of cancer in the same hospital where her mother worked as a nurse. The mother tried her best to keep her only child alive, slept in the next bed and left her daughter only to go to the toilet. At one of these moments, Michelle whispered to the nanny: "Please tell your mother, let her let me go." But this was impossible, and Michelle died only when her mother went out to dinner one evening.
1 Peter Matesen (born 1924) is an American writer, author of novels and travel books.
We need to not only decide where we would like to die, but also decide how conscious we want to be at the moment of death. Of course, death brings so many surprises that it is difficult to predict exactly how it will happen, but you can at least state your preferences. This is a tricky topic. Although the science of pain relief has taken a huge step forward in recent years, there are still many pitfalls. Since doctors for the most part are interested exclusively in the body and pay little attention to the quality of consciousness of a dying person, we ourselves will have to determine the extent of suffering that we are ready to endure on our deathbed in order to remain in full consciousness, not intoxicated with drugs.
Is it possible that doctors, who do not pay attention to the need to meet death with open eyes, create, by their efforts aimed at relieving the patient from pain, another kind of suffering? As a proponent of conscious aging and dying, I tend to give an affirmative answer to this question. The ministers of materialistic medicine focus on what can be seen, felt, and measured. Considering that the patient's existence ends with the death of the body, doctors pay little attention to death and dying as such - as a phenomenon that affects the future incarnation. Therefore, we, as wise elders who try to look at ourselves from the point of view of the soul, cannot entrust our consciousness to doctors at the last hour.
The wisest decision would be to take the pain reliever yourself. Experiments have shown that patients who are allowed to take their own pain medication consume less of it, but report less pain.
Recent studies in which women in labor were allowed to self-administer pain relievers found that these women were taking about half of the commonly prescribed dose. Two explanations were found for this: firstly, those giving birth could adjust the dose in accordance with their needs, and secondly, they were much less afraid of pain, since they knew that they could control it. I do not
i doubt that if the same study were carried out among the dying, there would also be a decrease in the dose of drugs.
Since a considerable time passes between the onset of pain and the receipt of pain medication, many dying people I knew anticipated the onset of pain and overestimated its intensity - after all, they themselves were not given control over it. In some English hospitals, patients are allowed to take painkillers of their own accord, and we should be smart enough to demand as much autonomy as possible in this area. Transferring power over your consciousness to another person in the process of dying - especially one whose philosophical values \u200b\u200bmay be completely different from ours - is a frightening prospect.
No less important is the question of whether we have the right to independently choose the moment of our death. We currently do not have such a right. If we want to die, then we will have to turn to Doctor Kevorkian1 or we will try to get more sleeping pills from our doctor. Both the one and the other way out cannot be considered satisfactory. Without intending to offend Dr. Kevorkian, I must nevertheless note that the discussion that has unfolded around his work brings to the public what should be a personal matter of a person, and draws attention to the patient's relatives at the most inopportune moment for them. Not that I underestimate the complexity of the ethical issues surrounding the right to death debate, but it seems to me that they ignore the most important thing: the dying person's wisdom and his ability to make conscious choices. In my work, I made sure that dying people assess the state of their body and mind quite soberly (except for those cases when a person is too weak to think clearly, or when he faints from pain).
1 Jack Kevorkian (born 1928) is an American pathologist who received the nickname "Doctor Death" in 1956 for his article "The fundus of the eye and the definition of death", which dealt with photographing the eyes of dying patients. In 1989, J. Kevorkian designed a "suicidal machine", and in the next ten years he helped more than a hundred terminally ill people voluntarily die. Tried to found a "suicide clinic". His activities caused a wide public outcry and became the subject of numerous legal proceedings.
To deprive them of the right to die the way they want and when they want is to deny their wisdom or consider it irrelevant. From a materialistic point of view, such a prohibition is fully justified, but from a spiritual perspective it looks completely wrong.
Life is wonderful and precious, and if asked, I will certainly urge everyone with at least a little consciousness to live as long as possible. But, if inner wisdom requires another, this voice must be heeded. The more we weed our deepest wisdom, removing the weeds of the voice of the ego from it, the better prepared we will be to make that decision if we ever have to make it.
Unlike our society, in cultures such as Tibetan, the right of a person to determine the time of his departure has never been questioned. Traditionally, when old lamas in Tibet feel that their time has come, they invite people to leave the body. At the appointed hour, the lama, immersed in meditation, stops the heart and stops breathing. And what, is this suicide? An immoral act? Or just knowing the timing of leaving? It is up to a specific person to decide, not the state.
You should ask yourself bluntly: is life extension at any cost always the wisest decision? In his old age, Thomas Jefferson1 wrote to a friend who was also over seventy: “The time comes when, taking into account our condition and with an eye to those around us, it would be wise to leave, making room for new growth. We have lived our own age and should not claim another one ”.
- The disease can come to a stage when a person willy-nilly thinks about death. Do I need to drive away these thoughts? If a person has already accepted that he is dying, and his loved ones have already accepted that he is dying, does it not work out that he stops fighting?
I believe that it is not necessary and not useful to drive thoughts of death - neither in health, nor in illness. First, when a person accepts the fact that he is facing death (and all people are mortal ...), he will not live superficially, and evaluate the time that he has left, therefore, relations with loved ones can become sincere, without lies. Secondly, when a person accepts the fact of death, this reduces anxiety and, to a certain extent, the fear of death. With his attitude to death, he takes responsibility, and by this he chooses the path of freedom, not sacrifice.
Now he is able to prepare mentally and spiritually for his transition into eternity. He can calmly manage the completion of his earthly affairs and internally untie all the knots that prevent him from finding peace of mind. If a person manages to work on himself in this way and look into the eyes of impending death, his physical, mental and spiritual condition improves. When a person accepts this fact, thereby the relationship with relatives and friends becomes real, without any falsity. Together they can live in the present and rejoice that time is still given.
- Why is it useful to remember about death?
Because if we do not remember death, we will live superficially and in constant fear. For the believer, due to the fact that Christ Himself died on the cross and was Risen, death is not the end, but the dormition and birth into Life. After all, the Apostle Paul says that if we do not believe in our resurrection, then we are the worst of all.
Father John Krestyankin spoke about death: “Death is a dream, a transition to another life. And everyday adversity is an exam of spiritual maturity. And the fact that from the moment of birth every day we are approaching our end is an indisputable fact. Death is a transition to the world into which we were born by baptism. "
In Vladyka Anthony of Sourozh, one can read that suffering, illness, or simply pain in life can be a means of drawing closer to God, to Christ. We can strive to achieve what he said: "Let us become a pure spirit and soul, so that any mental pain or suffering in the body is not the fruit of death in us, but our unity with Christ." Here, in Russia, they often talk about the last judgment, that there is a punishing God who is waiting for you and who will punish you. Vladyka Anthony of Sourozh never spoke about this. Once I asked him: "Why don't you talk about this?" He simply replied, "I don't know such a God." He did not say that this is not so, but "I do not know such a God." And he writes somewhere that after death there will be a meeting with our Savior, a meeting with immeasurable Love, and that He will meet us with pain that we have lived our whole life so fruitlessly. Christ's gaze on us will express only pity and compassion. And this, in the opinion of Vladyka Anthony of Surozh, is hell. Precisely in the fact that we will be burned with shame that we knew His love, that He died for each of us in love, and that we bore so little fruit.
- How and why to prepare for death?
Preparation for death is not preparation for the end, it is preparation for Life, for meeting Christ, for the transition into eternity. But getting sick in the body is always difficult, and preparing for death is not an easy task.
Vladyka Anthony believes that one should start preparing for death early, earlier than when a person is already facing death, because when the body is sick, when everything is difficult, when the consciousness is under the influence of drugs, then it is more difficult to prepare for death. It is extremely important to accept death as an inevitable fact of life, to accept the inevitability of our departure, because without this we will not be able to fully live the rest of our life (and life in general), no matter how many decades or days we have left.
- Can you give examples of people who properly prepared for death?
I can give an example from the life of my family. My sister died of cancer, unexpectedly. She lived in Holland, was a psychiatrist, was always healthy. And suddenly it was discovered that the temperature was increased and did not decrease. It turned out that intestinal cancer, and already metastases in the liver. Then the doctors said that she had three months to live.
She was not a particularly religious person; she lived as we all do. Longing for God was, but deep in my soul. When she found out her diagnosis, she realized that this was also connected with her inner experiences and negative emotions. What struck me was her determination. She bravely, every day, locked herself in her room and was not available to anyone for three hours. I was just praying, or pondering, I don't know what she did exactly, but she remained alone with herself and somehow worked through her life and what lay ahead. And she did this until her death, although the pains were already strong.
You rarely meet a person who takes responsibility for what happens to him. And this, of course, is repentance. She always told me: "I am not a cancer patient, I am the one who has always been." She refused to be a victim, refused to dissolve in her illness. This is extremely important because people are simply drowning in their illness instead of admitting: "Yes, there is a serious problem, yes, there is an incurable disease, but I am more than my illness." She seriously and consciously prepared for the transition, but lived a full life within the framework of her illness.
Before her death, she was baptized into Orthodoxy. When she was dying (at home), I was in Russia (I was not given a visa, so I was not near her). I asked her close friends who were next to her: "how did she die?" They replied: “She sat in a chair because it hurt until three or four in the morning, and then she became very peaceful. And when she died, we were all amazed at how bright she was. When they carried her body out, the person who was doing it stopped and said: “Wow! I have never seen a deceased person in my life who would be in such peace and quiet. "
I'm sure that praying for her also played a role, of course, but the way she left was also influenced by the fact that she had the courage to honestly look into her past life, that is, to analyze what was happening, what was in her soul it was negative, at whom she was angry, what grievances remained in her soul, with the aim of surviving them to the end, being able to throw them off and thus gain peace of mind. When we last spoke with her on the phone, she told me: “You know, when you face death, everything changes, and what was difficult to accept from loved ones, it all disappears” ...
Another example. Vladimir lay with us many times, he moved in a wheelchair, he had bladder cancer, and he could never lie down because it hurt. But, moving in a wheelchair, he met with all the medical staff. There was a lot of cynicism in him, but gradually he became more open. He often told me: "I would like so much, Frederica, for you to get to know my wife, she is so good." I asked: "Well, tell me about your wife." - “She is like that, she is the head of the school, she often cannot be here, because she works, but she is SO good,” he said. And I answered: "Well, someday we will meet" ...
We met her when he was already dying. This time he was lying in bed, and his wife was sitting next to him. He was already almost unconscious. He felt her pain as he was leaving. She had a deep sense of guilt because she rarely visited him because of her busy work. She talked about it, and therefore could not let him go. I saw that he was almost rising from nothing to comfort her, because she is his love. He couldn't die until she calmed down. Then I told her: "You know, it happens when people do not know how to let go of their loved ones, clinging to them, that they prevent them from quietly passing into eternity." I told her about it before leaving home. He died early the next morning. When I met her at the funeral, she told me: “You know, Frederica, when you told me about this, at first I did not understand anything, and then at night I realized that I would not let him go. And as soon as I could say from the bottom of my heart, "Volodya, I'm letting you go," he closed his eyes, the pain became less, and he died soon after. "
It seems to me that this is such a greatness of spirit when a person facing death, experiencing such pains, takes such care of his wife. You can read about this in Viktor Frankl, who writes from his experience in a concentration camp that it is important not to think about “why it is worth living”, but on the contrary - “what can I GIVE to life, and not what I can TAKE”?
( 7 Votes: 5 out of 5)
For a Christian, death is the main event in life for which we prepare, starting with Baptism. Death is the transition of a person's soul from the material world to the spiritual universe, this is the final realization of freedom of choice, this is the day of the beginning of the judgment over a person. As the word of the Lord preserved in Holy Tradition says:
In what I find, in that I judge.
There is no repentance after death, and therefore the Orthodox have developed a practice of preparing for this most important moment. Bearing in mind that death can come suddenly, according to the Russian proverb: “Death is not far off, but behind us,” we always try to prepare for death, even when nothing foreshadows its approach. But we must become especially attentive when we learn that we have a fatal illness (and hiding it is a grave sin for doctors and relatives). A dying person should not fall into despair, as the atheists do, but immediately begin the last "fit" of his life. He stops all unnecessary things (career, taking care of his tomorrow and children) and sinful relationships. For example, a smoker quits tobacco, a fornicator breaks off a shameful bond, a drunkard stops drinking, a debtor pays off his debts, a thief gives back the stolen goods. We must remember if there is a person with whom we have not yet reconciled, and be sure to ask him for forgiveness, as the Lord said: “Make peace with your adversary quickly, while you are still on the way with him, so that the adversary will not give you over to the judge, and the judge would not give you to the servant, and they would not throw you into prison; Truly I say to you: you will not get out of there until you give up to the last penny " (Matthew 5.25-26).
Likewise, the offended person must make peace with the dying person so that the wrath of God does not fall on him. There was a case when two friends who lived in the Kiev-Pechersk Lavra quarreled. One of them, Hieromonk Titus, became terminally ill and decided to ask forgiveness from his former comrade, Hierodeacon Evagrius. He did not want to forgive. Then he was forcibly dragged to the bed of the dying man. Titus crawled out of bed and, falling to his knees, asked forgiveness. But the proud deacon exclaimed:
I will not forgive him either in this life or in the next!
And suddenly he fell down dead, and Titus got up from the floor healthy. Everyone was surprised, and Titus told them that he saw a formidable Angel who stood next to him and threatened to punish him for the offense. But when Titus asked for forgiveness, and Evagrius did not forgive him, the Angel pierced the hard-hearted one with a fiery spear, and Titus healed with a touch.
Dying sickness must be endured with prayer and gratitude, remembering that suffering endured with patience cleanses a person from sins. At this time, you need to take communion more often, visit temples and shrines, be more attentive to those close to you. In ancient Russia, it was customary at this time to take monastic tonsure. This is the time for the study of Holy Scripture and patristic literature.
When the state of the dying person does not give him the opportunity to visit the temple, then one should pray at home. When thoughts of despondency and despair are attacked, one should read the Gospel and the Psalter. In this case, it is necessary to receive communion more often at home. It is very useful to accept the Sacrament of Unction, which gives the gift of painless death.
Behold, the day of death is approaching. Usually, relatives and close people gather to a Christian to support him with prayer and consolation in his last hour. But, most importantly, they invite a confessor or just the nearest priest who admonishes the dying. First, a person sincerely confesses all his sins throughout his life and accepts the Body and Blood of Christ. According to the rules of the Church, a dying person receives communion, even if he has eaten food and has not read the rules. In the Trinity-Sergius Lavra there was a case when a deacon died immediately after the Liturgy. Later he appeared to one of his friends and when asked how he passed the outposts of the prince of darkness, he replied: "Like lightning I swept past them, for the grace of Holy Communion."
But one can only commune when the dying person is conscious. During a coma, it is unacceptable to teach any Sacraments, except for Baptism (and then only if the person wanted to be baptized, but did not have time).
If before during his illness he did not receive the Unction, then he will be called into unction. And after that the priest reads the "Canon for the Separation of the Soul from the Body." In it, on behalf of the dying man, he asks Christ and the Mother of God to help him pass the airy region where the devil reigns, and to appear justified before the Throne of God. And after the canon, the priest reads a prayer for the exodus of the soul, with a request to cleanse it of all evil and leave in peace.
If dying is accompanied by severe agony, then the priest performs the "Chin, to separate the soul from the body, when a person suffers for a long time."
If the priest is not around, and the person dies and is attacked by demons, then it is necessary for the family to read the Gospel and sprinkle the dying with holy water. But still the most effective help can be provided by Holy Communion, for the sake of which, according to the rules of the Church, the priest is even obliged to interrupt the service (except for the Eucharistic canon). Do not be ashamed to disturb the priest at any time of the day if the patient may die. Indeed, a grave sin will fall on relatives who did not help to admonish the dying.
The author knows a case when a priest was invited to a dying woman. When he arrived, he saw a terrible sight - the patient lay with bulging eyes and tried to fight off invisible creatures attacking her from all sides with her hands.
I'm afraid, I'm afraid! she shouted, and no one could help her. The priest asked her if she would like to receive the Holy Communion, and she answered: "Yes!" After that, she lost her speech and only looked with horror at the terrible torturers standing around. But as soon as she received the Holy Communion, then immediately a smile appeared on her lips, an expression of peace appeared on her face, and a few minutes later she died in the world. So it is impossible in any case to delay the parting words. It is necessary to ask about this - whether a person wants to receive communion (and an unbaptized person wants to be baptized) - from anyone, regardless of whether he believed before or not. Indeed, when approaching the death line, many have their spiritual eyes opened, and they begin to see the reality that they previously rejected.