***Xiu Reading-49丨Final Farewell: There is a better choice

Many of us have experienced the death of a loved one. We have seen with our own eyes their pain and struggle in the face of death. At that time, and probably all along, we insisted on letting the doctors rescue them, and did not give up until the last moment.

So, have you ever thought about what you would think if one day you were lying in a hospital bed?

What do you want your family to do, what do the doctors do, and how do you want to spend your last days?

It is taboo for Chinese people to talk about death. In our education, there has never been death education.

Our understanding of death comes from our own experience. Once this process really comes, most people will be caught off guard, confused, scared, confused, and in pain.

In fact, this phenomenon is not an isolated phenomenon.

According to the "Quality of Death Index 2015" report published by The Economist, among the 80 countries and regions around the world surveyed: the United Kingdom ranked first in the quality of death, and Taiwan, China ranked sixth. , ranking 71st in mainland China.

The "Death Quality Index" is a comprehensive score based on factors such as end-of-life and medical care environment, human resources, people's affordability of death services, service quality, social participation and other factors.

Then why is our death quality index so low? How to achieve a “good death” or a “good death”?

Good death is the most important indicator for evaluating the quality of death. This is what this lesson is about, the best farewell is that there can be better choices.

Six requirements for a "good death"

I believe that in order to achieve a "good death", we need to start from three levels: personal growth, medical warmth, and social support.

Let’s talk about the first level first: one’s own growth. In other words, you need to understand what a “good death” is.

In European and American countries, there are six requirements for a good death, which are very close to the Chinese understanding of a good death. As long as you understand these six points, you will also understand the true meaning of a good death and achieve growth.

1. Pain-free death.

When death approaches, the body's electrolyte and acid-base balance will be disturbed, cancer invasion and metastasis, muscle stiffness, long-term bed rest, etc. Various factors will cause severe and unbearable pain to the patient.

Therefore, the first and most important aspect of a good death is to be painless. Waiting to die in pain not only speeds up death, but also makes the process very inhumane.

2. Open acknowledgment of the imminence of death.

Do not avoid death and clearly understand that death is a part of life. Only by recognizing that this process is inevitable and must be experienced by everyone can we truly make death quality.

3. Death at home, surrounded by family and friends.

When you are about to die, you will have a longing for family and friendship, and you will be reluctant to leave. The process of death is also a process of saying goodbye, which is also an important part of a good death.

4. An "aware" death—in which personal conflicts and unfinished business are resolved (An "aware" death—in which personal conflicts and unfinished business are resolved).

Modern medicine can almost solve most physical pain, but if the patient still has some inner tangles or some unfulfilled wishes, then this is also another form of pain. Before you die, you can achieve peace by letting these unfulfilled wishes come true.

5. Recognize death as personal growth.

A correct understanding of death is also personal growth.

6. Death according to personal preference and in a manner that resonates with the person’s individuality.

Provide psychological and spiritual care based on individual religion and beliefs. For example, some scholars use "butterfly imagery" to compare death to the transformation of a cocoon into a butterfly, telling patients that they will be like butterflies after death and will be free from pain.

For another example, using religion and faith to appease the dying are both spiritual and psychological concerns. At this time, they cannot all be replaced by medical technology.

Understanding these six points of "good death", we will achieve personal growth regarding death.

Palliative care makes death more dignified

So, how to make the process of death painless and dignified? This relies on medical warmth, which is the second level.

Whether it is excessive rescue or insufficient treatment, it will bring pain to the patient.

Excessive resuscitation, using various advanced instruments and equipment to technicalize the death process, although prolonging life, also prolongs suffering.

Insufficient treatment and failure to promptly and effectively intervene in physical pain and various discomforts during the death process also make the process full of pain.

Some scholars believe that one of the main reasons why the United Kingdom, the United States, Japan, and Taiwan, China, rank high in the death quality index is that they took the lead in promoting palliative care. Palliative care is to use medical warmth to make death more dignified.

The World Health Organization (WHO) defines palliative care as follows:

Palliative care is a type of care provided to patients and families suffering from life-threatening diseases. , a systematic approach aimed at improving their quality of life and ability to face crises. Through early identification of distress and pain, rigorous assessment and effective management, all (including psychological and spiritual) needs of patients and families are met.

Palliative care has three principles:

Value life and recognize that death is a normal process;

Neither accelerate nor delay death;

Provides relief from end-of-life pain and discomfort.

Palliative care neither leaves terminal patients waiting to die nor gives them false hope. It allows patients to die comfortably and with dignity based on the principles of minimum harm and maximum respect.

There are various names for palliative care, such as palliative care, hospice care, palliative care, etc. It was first proposed and carried out by a British nursing scientist in the 1960s, and has since been gradually promoted to a large extent in many countries. In mainland China, it started late.

To understand palliative care, some misunderstandings must be avoided.

First of all, palliative care is not euthanasia.

Palliative care does not hasten or delay death. It is different from euthanasia, which uses a relatively radical method to reduce the patient's pain and accelerate the death process.

In the world, including China, euthanasia may not be widely accepted by the public for a while, but palliative care is more easily accepted than euthanasia.

Secondly, palliative care is not about “letting nature take its course.”

The natural process of most deaths is painful, and it is inhumane to let it take its course. Palliative care uses active medical methods to intervene in pain. Its most important and core point is to relieve pain and allow patients to die with dignity. For example:

Replenish water to prevent the patient from dying of dehydration;

Use morphine and other analgesics to prevent the patient from enduring pain;

Help the patient move Limbs, reduce the pain of stiff limbs;

Treat nausea and vomiting, help patients relieve anxiety, restlessness, and delirium, use diuretics to reduce patient edema;

Give oxygen and use drugs to reduce respiratory tract pain secretions to improve the patient's dyspnea.

These medical measures are important means of palliative care and can greatly improve the quality of death. There is no doubt that this is the most humane approach. It uses medicine to allow patients to spend the last part of their lives with dignity.

Finally, palliative care is not only a purely medical intervention, but also a comprehensive intervention at three levels: physical, psychological and spiritual. The concepts and principles of palliative care reflect the warmth of medicine.

Living will is a better choice

But here comes the problem. Everyone is a member of society and family. Although the right to life is decided by the patient himself, in reality is still full of difficulties. For example, if a patient is comatose or otherwise loses the ability to choose, how can we preserve the dignity of life at this time?

Family members may have conflicting opinions and be unable to coordinate, and may even publicly confront each other and blame each other. There are many cases that go to court. In reality, the implementation of dignity death and palliative care will face various practical difficulties.

What to do?

This brings us to the third level of this lesson: social support.

Please read a letter first.

On March 12, 2017, the famous writer Qiong Yao published her open letter on Facebook. This letter was written to her eldest son Chen Zhongwei and her daughter-in-law He Xiuqiong. The original text is too long, here is an excerpt:

Although Zhongwei has repeatedly said that he fully understands my wishes, agrees with me, and will comply with all my wishes. But I am afraid that when the time comes, your love for me will become the biggest obstacle to my "natural death".

My advice is as follows:

1. No matter what serious illness I get, the most important thing is that I die quickly without major surgery! Let me make the decision when I can make the decision. If I can’t make the decision, just follow my instructions!

2. Don’t send me to the intensive care unit (ICU).

3. Under no circumstances should a nasogastric tube be inserted! Because if I lose the ability to swallow, I also lose the joy of eating. I don’t want to live like that! (A nasogastric tube is a nutritional tube that is placed through the nose into the stomach.)

4. Same as the previous one, no matter what the circumstances, various life-sustaining tubes cannot be inserted into my body. Urinary tubes, breathing tubes, all kinds of tubes that I don’t know the names of will not work!

5. I have already noted down the final first aid measures, tracheotomy, electric shock, and leaf membrane. None of these are needed! Helping me die without pain means more than trying every possible means to make me live in pain! Don’t be confused by the myth of life and death! (Ye Kemo is ECMO, also called "Magic Lung", which is used to support breathing and heart.)

The famous writer Qiong Yao

This letter from Teacher Qiong Yao is essentially a Living Will. A living will is a way for a person to give advance instructions regarding his/her illness or death if he or she has clear thinking.

Although I personally believe that many of the conditions mentioned by Teacher Qiong Yao can still be cured or restored by today’s modern medicine, but this is not the most important thing. Most importantly, as a well-known author and public figure, she used the form of a living will to promote a scientific view of life and death.

Compared to differences of opinion among family members or unwillingness to part ways because of family ties, a living will is a better choice.

Living wills require social support.

Anyone who is over 18 years old and has full capacity for civil conduct can make arrangements for his or her life in this way. In our country, there are already public welfare organizations and websites about living wills. If you are interested, you can check it out.

The content of the living will is realized through "my five wishes", including:

1. What medical services do I want or not want.

2. I hope to use or not use life support treatment.

3. How do I want others to treat me.

4. What do I want my family and friends to know?

5. Who do I want to help me?

In some countries, legislation is passed to support the implementation of living wills.

For example, in 1976, California passed the Natural Death Act, which allowed patients to prolong the dying process of incurable patients without using life support systems, that is, allowing patients to die naturally according to their own wishes. die.

In our country, although living wills do not have the protection of the Succession Law like wills, there is a legal risk of not being followed in practice. But there is no doubt that it is a useful exploration in promoting a dignified death.

Key points

1. A correct understanding of death can allow people to die with dignity.

2. Your own growth, social support, and medical warmth are the solutions to improve the quality of death.

3. The meaning of a good death includes 6 levels. Palliative care and living will are currently useful attempts to achieve a good death.

Questions to think about

After today’s lesson, can you talk about your five wishes regarding “good death”? Welcome to leave a message in the comment area and communicate with everyone.

1. If the treatment is very painful, I am not willing to accept auxiliary medical treatment with equipment that can bring more pain. I would rather wait to die quietly.

2. I hope that my family and friends, especially the people I love the most, can stay with me without being sentimental, so that I can leave in peace and comfort.

3. I want my family to know that I love them. Although I have done something wrong, my love for them has never changed.

4. If it can alleviate the pain, I am willing to accept some auxiliary medical treatment that can relieve the pain.